Provider Demographics
NPI:1790876753
Name:WALLS, RENEE ARLENE
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:ARLENE
Last Name:WALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71999-0001
Mailing Address - Country:US
Mailing Address - Phone:870-230-5102
Mailing Address - Fax:870-230-5064
Practice Address - Street 1:1100 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71999-5020
Practice Address - Country:US
Practice Address - Phone:870-230-5102
Practice Address - Fax:870-230-5064
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01564ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily