Provider Demographics
NPI:1326071275
Name:REYNERSON, LORI D (APN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:D
Last Name:REYNERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:D
Other - Last Name:TALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1809 CARRIE PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5703
Mailing Address - Country:US
Mailing Address - Phone:479-751-9281
Mailing Address - Fax:
Practice Address - Street 1:525 N GARLAND AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-3110
Practice Address - Country:US
Practice Address - Phone:479-575-6479
Practice Address - Fax:479-575-8793
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01027363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health