Provider Demographics
NPI:1477321917
Name:REYNOLDS, KINDAL DAWN (APRN)
Entity Type:Individual
Prefix:
First Name:KINDAL
Middle Name:DAWN
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 1:205 WHITE OAK ST
Mailing Address - Street 2:
Mailing Address - City:GENTRY
Mailing Address - State:AR
Mailing Address - Zip Code:72734-4004
Mailing Address - Country:US
Mailing Address - Phone:479-629-6193
Mailing Address - Fax:
Practice Address - Street 1:643 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GENTRY
Practice Address - State:AR
Practice Address - Zip Code:72734-8258
Practice Address - Country:US
Practice Address - Phone:479-736-2213
Practice Address - Fax:479-373-6095
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily