Healthcare Provider Details

I. General information

NPI: 1942671730
Provider Name (Legal Business Name): COURTNEY LAYNE MOSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY LAYNE REYNOLDS PA-C

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 PARKWAY CIR
SPRINGDALE AR
72762-6362
US

IV. Provider business mailing address

3901 PARKWAY CIR
SPRINGDALE AR
72762-6362
US

V. Phone/Fax

Practice location:
  • Phone: 479-587-1700
  • Fax: 479-587-1366
Mailing address:
  • Phone: 479-587-1700
  • Fax: 479-587-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number312218
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-642
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: