Healthcare Provider Details

I. General information

NPI: 1063329373
Provider Name (Legal Business Name): REAGAN A GUESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 N COLLEGE AVE STE 108
FAYETTEVILLE AR
72703-3500
US

IV. Provider business mailing address

1703 SW HAYFIELD AVE
BENTONVILLE AR
72713-7931
US

V. Phone/Fax

Practice location:
  • Phone: 479-957-9121
  • Fax:
Mailing address:
  • Phone: 479-321-4866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: