MEDICARE: RAYNA PENISTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E-11681	AR

General Provider Information

NPI Number	:	1619354818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAYNA PENISTER

Provider Business Mailing Address
First Line	:	PO BOX 251420
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72225-1420
Country	:	US
Telephone Number	:	501-686-5021
Fax Number	:	501-526-5148

Provider Business Practice Location Address
First Line	:	1601 W 40TH AVE
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-6069
Country	:	US
Telephone Number	:	870-541-6000
Fax Number	:	870-541-6034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	05/18/2022

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Directions to “ RAYNA PENISTER ” Practice Location

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