Individual provider Active NPI

Nicholas Rodman Bahner, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Fayetteville, AR
National Provider Identifier
1902660756
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
227466 Issued in AR
Practice address
2566 E Joyce Blvd Ste 2
Fayetteville, AR 72703-3923
Phone
(479) 935-1000
NPI assigned
Feb 12, 2024
Last updated
Feb 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 227466 AR Primary

Addresses

Primary practice location

2566 E Joyce Blvd Ste 2
Fayetteville, AR 72703-3923

Mailing address

6111 SW Osage St
Bentonville, AR 72713-5380
Phone (479) 352-0657

Other names 1

  • Nick Bahner Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240410000316 AR Practitioner - Nurse Practitioner 6507204567 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Reding and Leach MD PLLCGroup PAC ID 7012258627, 62 clinicians

Practice addresses (Care Compare)

2566 E Joyce Blvd
Suite 2
Fayetteville, AR 72703-3923
Phone (479) 935-1000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
227466ARMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Reding & Leach MD PLLC CurrentSince Mar 1, 2024 Accepting new patients

Locations

706 S Walton Blvd
Bentonville, AR 72712
Phone (479) 715-8002

706 S Walton Blvd
Ste 2
Bentonville, AR 72712
Phone (417) 691-6969

2566 E Joyce Blvd
Ste 2
Fayetteville, AR 72703
Phone (479) 935-1000

11501 Huron Ln
Ste 5
Little Rock, AR 72211
Phone (501) 904-4762

5305 W Village Pkwy
Rogers, AR 72758
Phone (479) 480-4892

5305 W Village Pkwy
Ste 12
Rogers, AR 72758
Phone (479) 405-4015

5306 W Village Pkwy
Ste 2
Rogers, AR 72758
Phone (479) 463-9533

Interoperability endpoints

  • Direct secure messaging: nicholas.bahner.1@21565.direct.athenahealth.com

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1902660756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6111 SW OSAGE ST",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727135380",
            "telephone_number": "479-352-0657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2566 E JOYCE BLVD STE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727033923",
            "telephone_number": "479-935-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAHNER",
        "first_name": "NICHOLAS",
        "middle_name": "RODMAN",
        "credential": "APRN, PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "227466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICK",
            "last_name": "BAHNER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.