MEDICARE: MS. CYNTHIA REDDICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1710399373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA REDDICK

Provider Business Mailing Address
First Line	:	4620 W COMMERCIAL DR
Second Line	:	SUITE C
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7057
Country	:	US
Telephone Number	:	501-753-8400
Fax Number	:	501-753-8401

Provider Business Practice Location Address
First Line	:	4620 W COMMERCIAL DR
Second Line	:	SUITE C
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7057
Country	:	US
Telephone Number	:	501-753-8400
Fax Number	:	501-753-8401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	05/29/2014

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