Mainline Health Systems Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MAINLINE HEALTH SYSTEMS INC

Doing business as

Mainline Dermott Medical Clinic

Practice address

210 S School St
Dermott, AR 71638-9012

Phone

(870) 538-5296

Fax

(855) 811-4203

NPI assigned

Aug 19, 2006

Last updated

Sep 25, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary Allan Nichols

Title

Ceo

Phone

(870) 942-3000

Specialties & licenses 2

Addresses

Other names 1

• Mainline Dermott Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386758043. Details of each certification follow.

• CCN 041809 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 041809

Legal name

MAINLINE HEALTH SYSTEMS INC

Doing business as

MAINLINE DERMOTT MEDICAL CLINIC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 1, 1991

Last certification

Oct 1, 1991

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Jul 1, 1978 in AR

Enrollment address

300 S School St
Dermott, AR 71638-2127

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Mainline Health Systems Inc

  dba Sheridan School

  • Federally Qualified Health Center (FQHC)
  • Sheridan, AR
  • NPI 1447994686

  O20041011000567

  Same enrollment
• Mainline Health Systems, Inc

  dba Mills Middle School

  • Federally Qualified Health Center (FQHC)
  • Little Rock, AR
  • NPI 1164264834

  O20041011000567

  Same enrollment
• Mainline Health Systems, Inc

  dba Warren Elementary School

  • Federally Qualified Health Center (FQHC)
  • Warren, AR
  • NPI 1386322766

  O20041011000567

  Same enrollment
• Mainline Health Systems, Inc

  • Specialist
  • Portland, AR
  • NPI 1407650179

  O20041011000567

  Same enrollment
• Mainline Health Systems, Inc

  • Federally Qualified Health Center (FQHC)
  • Rison, AR
  • NPI 1437960929

  O20041011000567

  Same enrollment
• Mainline Health Systems, Inc

  dba Brunson Elementary School

  • Federally Qualified Health Center (FQHC)
  • Warren, AR
  • NPI 1578282372

  O20041011000567

  Same enrollment
• Mainline Health Systems, Inc

  • Federally Qualified Health Center (FQHC)
  • Monticello, AR
  • NPI 1669401501

  O20041011000567

  Same enrollment
• Mainline Health Systems, Inc

  dba Warren Middle School BH

  • Federally Qualified Health Center (FQHC)
  • Warren, AR
  • NPI 1710606504

  O20041011000567

  Same enrollment
• Mainline Health Systems, Inc

  dba Warren Eastside School

  • Federally Qualified Health Center (FQHC)
  • Warren, AR
  • NPI 1922727726

  O20041011000567

  Same enrollment
• Mainline Health Systems, Inc

  dba Warren High School BH

  • Federally Qualified Health Center (FQHC)
  • Warren, AR
  • NPI 1942929732

  O20041011000567

  Same enrollment

Locations

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

All facility ownership & control disclosures 26

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Rebekah Ayecock, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Dermott, AR
  • NPI 1104251180
  NPD
• Jennifer Cotton, CASE MANAGER

  • Clinical Social Worker
  • Monticello, AR
  • NPI 1811024276
  NPD
• Kimberly Kay Golden, M.D.

  • Family Medicine Physician
  • Rison, AR
  • NPI 1003038167
  NPD
• Jaime B Harvey, MS, LAC

  • Professional Counselor
  • Monticello, AR
  • NPI 1215158563
  NPD
• Hannah A Hilton

  • Family Nurse Practitioner
  • Monticello, AR
  • NPI 1487290961
  NPD
• Jessica Danya Jackson, FNP

  • Family Nurse Practitioner
  • Warren, AR
  • NPI 1750013439
  NPD
• Mollye Jenay Koonce, APRN, FNP-C

  • Family Nurse Practitioner
  • Sheridan, AR
  • NPI 1497271456
  NPD
• Kendal Noble, APRN

  • Family Nurse Practitioner
  • Star City, AR
  • NPI 1558831644
  NPD
• Kerry Franklin Pennington, M.D.

  • Family Medicine Physician
  • Warren, AR
  • NPI 1013983873
  NPD
• Dana Shea Phillips, FNP-BC

  • Family Nurse Practitioner
  • Dermott, AR
  • NPI 1659710879
  NPD
• Karen J. Richardson, APN

  • Family Nurse Practitioner
  • Warren, AR
  • NPI 1285600049
  NPD
• Holley Shelton, APN-NP

  • Family Nurse Practitioner
  • Star City, AR
  • NPI 1629337738
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790294400000",
    "number": "1386758043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "342 HIGHWAY 425 S",
            "city": "MONTICELLO",
            "state": "AR",
            "postal_code": "716554612",
            "telephone_number": "870-942-3000",
            "fax_number": "870-942-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S SCHOOL ST",
            "city": "DERMOTT",
            "state": "AR",
            "postal_code": "716389012",
            "telephone_number": "870-538-5296",
            "fax_number": "855-811-4203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINLINE HEALTH SYSTEMS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2026-09-25",
        "certification_date": "2026-09-25",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-942-3000"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mainline Dermott Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Case Henderson, PHARMD
• Shenika Jackson-King, APRN
• Courtney Shay Johnson, CNP
• Elmer Ann Johnson
• Courtney Keller, PHARMD
• Mainline Health Systems, Inc (Mainline Dermott Dental Clinic)
• Mainline Health Systems, Inc (Dermott School Clinic)
• Mainline Health Systems, Inc (Dermott School Dental Clinic)
• Marvin D. Loyd, DDS
• Medical Transport Management, Inc

• Federally Qualified Health Center (FQHC) in Dermott, AR
• Providers in Dermott, AR by specialty
• Federally Qualified Health Center (FQHC) in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.