Provider Demographics
NPI:1093174716
Name:REYNOLDS, CALLIE (APRN)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VITAL CARE OF LITTLE ROCK
Mailing Address - Street 2:15200 CHENAE PARKWAY SUITE 100
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-451-6080
Mailing Address - Fax:501-451-6081
Practice Address - Street 1:VITAL CARE OF LITTLE ROCK
Practice Address - Street 2:15200 CHENAE PARKWAY SUITE 100
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-451-6080
Practice Address - Fax:501-451-6081
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA004614363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care