Jefferson, Nina Nicole
Jefferson, Nina Nicole is an sole proprietor health care provider with primary practice located at 766 Hl Ross Dr , Monticello AR 71655. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Jefferson, Nina Nicole can be contacted via phone (870) 367-6246.Contact Information
Primary practice address
766 Hl Ross Dr
Monticello AR 71655
Phone: (870) 367-6246
Fax: (855) 926-7383
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY003323 | Georgia |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 15-06P | Arkansas |
Profile Details
| NPI number | 1881912137 |
|---|---|
| LBN Legal business name | Jefferson, Nina Nicole |
| Credentials | PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 12th, 2010 |
| Last updated | Jul 21st, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881912137 | NPPES |
| Georgia | MEDICAID | 003100346A |
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