Healthcare Provider Details

I. General information

NPI: 1417874611
Provider Name (Legal Business Name): REAGAN CODY APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23816 CHENAL PKWY
LITTLE ROCK AR
72223-9197
US

IV. Provider business mailing address

564 VALLEY HILL RD
BENTON AR
72019-9612
US

V. Phone/Fax

Practice location:
  • Phone: 501-476-7171
  • Fax:
Mailing address:
  • Phone: 501-681-3616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number237844
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: