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NPI Code Detail

MEDICARE: KACEE REYNOLDS APRN

MEDICARE: KACEE REYNOLDS APRN
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
1363LF0000XFamily Nurse Practitioner213443AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730841883
Entity Type Code : Individual
Provider Name (Legal Business Name) : KACEE REYNOLDS APRN
Provider Business Mailing Address
First Line : PO BOX 509
Second Line :
City : DERMOTT
State : AR
Zip : 71638-0509
Country : US
Telephone Number : 870-538-5414
Fax Number : 870-538-5412
Provider Business Practice Location Address
First Line : 110 N DREW ST
Second Line :
City : STAR CITY
State : AR
Zip : 71667-5704
Country : US
Telephone Number : 870-628-5110
Fax Number : 855-854-6281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2021
Last Update Date : 02/21/2023

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Directions to “ KACEE REYNOLDS APRN” Practice Location

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