Healthcare Provider Details

I. General information

NPI: 1346111416
Provider Name (Legal Business Name): CARLY REINA MSN, APRN, PMHNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 216
PHOENIX AZ
85032-3354
US

IV. Provider business mailing address

16601 N 40TH ST STE 216
PHOENIX AZ
85032-3354
US

V. Phone/Fax

Practice location:
  • Phone: 314-335-9388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number332175
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: