Healthcare Provider Details

I. General information

NPI: 1295664589
Provider Name (Legal Business Name): MICHELLE REYES MACIAS MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 JENNY LIND RD STE 2
FORT SMITH AR
72908-8629
US

IV. Provider business mailing address

2708 N 56TH CIR
FORT SMITH AR
72904-5800
US

V. Phone/Fax

Practice location:
  • Phone: 479-444-3566
  • Fax:
Mailing address:
  • Phone: 479-739-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236948
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: