Healthcare Provider Details

I. General information

NPI: 1194421339
Provider Name (Legal Business Name): REECE CHRISTOPHERSON MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

242 N SOLITUDE BND
FAYETTEVILLE AR
72704-4007
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-8000
  • Fax:
Mailing address:
  • Phone: 913-269-0979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA-1282
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: