Active NPI
Jessica Domino, PH.D.
- Psychologist
- North Little Rock, AR
National Provider Identifier
1518414010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY.0004502
- Practice address
- 2200 Fort Roots Dr # 116B
North Little Rock, AR 72114-1709 - Phone
- (501) 257-3481
- NPI assigned
- Sep 1, 2016
- Last updated
- Jul 20, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY.0004502 | CO | Primary |
Addresses
Primary practice location
2200 Fort Roots Dr # 116B
North Little Rock, AR 72114-1709
Mailing address
2500 Leestown Rd
116B
Lexington, KY 40511-1052
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY.0004502 | CO | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1472688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595203200000",
"number": "1518414010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 LEESTOWN RD",
"address_2": "116B",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405111052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 FORT ROOTS DR # 116B",
"city": "NORTH LITTLE ROCK",
"state": "AR",
"postal_code": "721141709",
"telephone_number": "501-257-3481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOMINO",
"first_name": "JESSICA",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-01",
"last_updated": "2020-07-20",
"certification_date": "2020-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CO",
"license": "PSY.0004502",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.