Healthcare Provider Details

I. General information

NPI: 1326071275
Provider Name (Legal Business Name): LORI D. REYNERSON A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LORI D. TALBERT R.N.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N GARLAND AVE
FAYETTEVILLE AR
72701-3110
US

IV. Provider business mailing address

1809 CARRIE PL
SPRINGDALE AR
72762-5703
US

V. Phone/Fax

Practice location:
  • Phone: 479-575-6479
  • Fax: 479-575-8793
Mailing address:
  • Phone: 479-751-9281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberA01027
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: