Provider Demographics
NPI:1639989304
Name:YODER, NICOLE LEA (NP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEA
Last Name:YODER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-362-0500
Mailing Address - Fax:501-362-0501
Practice Address - Street 1:1800 BYPASS RD
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-9135
Practice Address - Country:US
Practice Address - Phone:501-362-0500
Practice Address - Fax:501-362-0501
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226258363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily