Alicia Nichole Polk

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

License

6779 Issued in AR

Practice address

2612 S Walton Blvd
Bentonville, AR 72712-7558

Phone

(479) 395-1115

NPI assigned

Feb 24, 2025

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arkansas Permanent Cosmetics and Brickhouse Body Art Institute, LLC

  • Other Specialist/Technologist
  • Cabot, AR
  • NPI 1720892821

  Specialist/Technologist, Other

  NPD (past)

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

{
    "created_epoch": "1740355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740355200000",
    "number": "1548066194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2612 S WALTON BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127558",
            "telephone_number": "479-395-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2612 S WALTON BLVD",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127558",
            "telephone_number": "479-395-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLK",
        "first_name": "ALICIA",
        "middle_name": "NICHOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-24",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "AR",
            "license": "6779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Beth Platt, LCSW
• Cynthia R Plume, MHPP
• Nicole Plummer, LCSW
• Jessica Pointer, RBT
• Sherry Pointer, MS, LPC, TTS
• Christian Polovich, CNIM
• Erin Popejoy, PHD, LPC/S
• Ashley Porter
• Marymargaret Portera, MHPP
• Lauren Post

• Other Specialist/Technologist in Bentonville, AR
• Providers in Bentonville, AR by specialty
• Other Specialist/Technologist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.