Provider Demographics
NPI:1336141902
Name:REINERTSEN, KAREN J (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:REINERTSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7213
Mailing Address - Country:US
Mailing Address - Phone:870-972-4939
Mailing Address - Fax:870-972-4911
Practice Address - Street 1:28 SOUTHPOINTE DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-6238
Practice Address - Country:US
Practice Address - Phone:870-239-2244
Practice Address - Fax:870-236-1616
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16594174400000X
ARE-69662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5AJ66G677OtherMEDICARE
NE03825OtherBLUE CROSS BLUE SHIELD NE
AR5H936OtherBLUE CROSS AR
AR186894001Medicaid
AR5AJ66G677OtherMEDICARE