Provider Demographics
NPI:1588634687
Name:REYNOLDS, TARA P (MD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:P
Last Name:REYNOLDS
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 1:3201 SPRINGHILL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72117-2909
Mailing Address - Country:US
Mailing Address - Phone:501-534-4300
Mailing Address - Fax:
Practice Address - Street 1:3201 SPRINGHILL DR STE 300
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2909
Practice Address - Country:US
Practice Address - Phone:501-534-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4035207Q00000X
FLME89097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1669662615Medicaid
AR154104001Medicaid
ARI05689Medicare UPIN
AR57297Medicare PIN
AR154104001Medicaid