Provider Demographics
NPI:1376502690
Name:REID, CHRISTINA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:M
Last Name:REID
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:205 WESTPORT DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3657
Mailing Address - Country:US
Mailing Address - Phone:501-843-6585
Mailing Address - Fax:501-843-2380
Practice Address - Street 1:205 WESTPORT DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3657
Practice Address - Country:US
Practice Address - Phone:501-843-6585
Practice Address - Fax:501-843-2380
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARPA-228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR53411P078Medicare ID - Type Unspecified
ARQ37501Medicare UPIN