Provider Demographics
NPI:1861862914
Name:MCREYNOLDS WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:MCREYNOLDS WELLNESS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MCREYNOLDS BRINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, ACNS-BC
Authorized Official - Phone:479-224-6368
Mailing Address - Street 1:5300 S SOUTHERN HILLS CT STE 100
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-3500
Mailing Address - Country:US
Mailing Address - Phone:479-636-1324
Mailing Address - Fax:479-372-4433
Practice Address - Street 1:5300 S SOUTHERN HILLS CT STE 100
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-3500
Practice Address - Country:US
Practice Address - Phone:479-636-1324
Practice Address - Fax:479-372-4433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS02246261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366776429OtherNPI
ARS02246OtherAPRN LICENSE