Healthcare Provider Details

I. General information

NPI: 1801042247
Provider Name (Legal Business Name): MICHELE L REYNOLDS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 RIKE DR
PINE BLUFF AR
71603-3937
US

IV. Provider business mailing address

2500 RIKE DR
PINE BLUFF AR
71603-3937
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-1834
  • Fax: 870-534-5798
Mailing address:
  • Phone: 870-534-1834
  • Fax: 870-534-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA01350
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: