Provider Demographics
NPI:1780876896
Name:REECE, WYNETTE (RT, RPA (CBRPA))
Entity type:Individual
Prefix:
First Name:WYNETTE
Middle Name:
Last Name:REECE
Suffix:
Gender:F
Credentials:RT, RPA (CBRPA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SAGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7042
Mailing Address - Country:US
Mailing Address - Phone:501-278-4040
Mailing Address - Fax:
Practice Address - Street 1:3214 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4810
Practice Address - Country:US
Practice Address - Phone:501-380-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRT11922471C3402X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant