MEDICARE: NICKOLAS ALLEN RHOADES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	233889	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821637927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKOLAS ALLEN RHOADES

Provider Business Mailing Address
First Line	:	PO BOX 23120
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72221-3120
Country	:	US
Telephone Number	:	870-233-9960
Fax Number	:	888-630-8885

Provider Business Practice Location Address
First Line	:	4318 US-65
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601
Country	:	US
Telephone Number	:	870-233-9960
Fax Number	:	870-647-5223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	05/19/2026

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