Provider Demographics
NPI:1164687687
Name:SKIDMORE, NICOLE (MHPP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SKIDMORE
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72525-0176
Mailing Address - Country:US
Mailing Address - Phone:870-257-3336
Mailing Address - Fax:870-257-3339
Practice Address - Street 1:#4 E. CHEROKEE VILLAGE MALL
Practice Address - Street 2:
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529
Practice Address - Country:US
Practice Address - Phone:870-257-3336
Practice Address - Fax:870-257-3339
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator