Nicole Medina, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

12122C Issued in AR

Practice address

2705 Oak LN
Van Buren, AR 72956-4816

Phone

(479) 471-5950

Fax

(479) 471-5997

NPI assigned

Jan 2, 2024

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

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

University of Oklahoma College of Medicine, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Western Arkansas Counseling & Guidance Center, Inc

  • Community/Behavioral Health Agency
  • Fort Smith, AR
  • NPI 1326040692
  Medicare reassignment NPD
• The Guidance Center - Mena Clinic

  • Community/Behavioral Health Agency
  • Mena, AR
  • NPI 1356516579
  NPD
• The Guidance Center - Whole Health

  • Family Medicine Physician
  • Fort Smith, AR
  • NPI 1730787037
  NPD

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

{
    "created_epoch": "1704153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762300800000",
    "number": "1871363820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11818",
            "city": "FORT SMITH",
            "state": "AR",
            "postal_code": "729171818",
            "telephone_number": "479-452-6650",
            "fax_number": "479-452-5847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 OAK LN",
            "city": "VAN BUREN",
            "state": "AR",
            "postal_code": "729564816",
            "telephone_number": "479-471-5950",
            "fax_number": "479-471-5997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3111 S 70th St",
            "address_purpose": "LOCATION",
            "city": "Fort Smith",
            "state": "AR",
            "postal_code": "729035017",
            "country_code": "US",
            "telephone_number": "479-452-6650",
            "fax_number": "479-452-5847",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDINA",
        "first_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-02",
        "last_updated": "2025-11-05",
        "certification_date": "2025-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "AR",
            "license": "12122C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mahkenzie McGill
• Lisa K McGraw, MD
• Matthew B McLellan, MD
• Addison Hope McMillan
• Grayson McReynolds, DDS
• James Robert Medlyn, PTA
• Angie Melgar
• Memory Lane, Inc.
• Winter Mendenhall
• Tanya Renee Merrill, PHYSICALTHERAPY ASST

• Clinical Social Worker in Van Buren, AR
• Providers in Van Buren, AR by specialty
• Clinical Social Worker in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.