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General NPI Number Information
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NPI Number | 1205345386
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Entity Type | Individual
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Provider Name | BLAKELY REEDER NP
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Gender | Male
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 09/21/2017
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Provider Practice Location Address
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Address Line | 5201 NORTHSHORE DR
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City | N LITTLE ROCK
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State | AR
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Zip | 72118-5312
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Country | US
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Telephone | 877-918-7020
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Fax | 479-968-1673
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Provider Business Mailing Address
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Address Line | PO BOX 9178
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City | RUSSELLVILLE
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State | AR
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Zip | 72811-9178
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Country | US
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Telephone | 866-601-8435
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Fax | 479-968-1673
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | A005358
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License Number State | AR
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