Healthcare Provider Details

I. General information

NPI: 1043954084
Provider Name (Legal Business Name): HUNTER RENNIE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 EXCHANGE AVE
CONWAY AR
72032-7824
US

IV. Provider business mailing address

29 TARYN TRL
GREENBRIER AR
72058-5030
US

V. Phone/Fax

Practice location:
  • Phone: 501-585-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-18755
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: