NPIMap

Individual provider Active NPI

Michele L Reynolds, ANP

  • Psychiatric/Mental Health Nurse Practitioner
  • Pine Bluff, AR
National Provider Identifier
1801042247
Registry record updated Sep 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
A01350 Issued in AR
Practice address
2500 Rike Dr
Pine Bluff, AR 71603-3937
Phone
(870) 534-1834
Fax
(870) 534-5798
NPI assigned
Aug 18, 2008
Sex
Female
Sole proprietor
No

Organizations & group practices 21

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Arkansas College of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthy Connections Incorporated 23 clinicians

Practice addresses (Care Compare)

208 McAuley CT
Suite B
Hot Springs, AR 71913-6344
Phone (888) 710-8220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
I20081017000428 AR Practitioner - Nurse Practitioner 8224196308 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A01350ARMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Arkansas Behavioral Healthcare System Inc CurrentSince Aug 18, 2008 Accepting new patients
Southeast Arkansas Behavioral Healthcare System Inc Past Accepting new patients

Locations

2500 Rike Dr
Pine Bluff, AR 71603
Phone (870) 534-1834

121 Commercial Dr
#B
Stuttgart, AR 72160
Phone (870) 627-1633

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X A01350 AR Primary

Addresses

NPPES NPI Registry

Primary practice location

2500 Rike Dr
Pine Bluff, AR 71603-3937

Mailing address

2500 Rike Dr
Pine Bluff, AR 71603-3937
Phone (870) 534-1834

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
116378726MedicaidAR

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 26, 2008.

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222387200000",
    "number": "1801042247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 RIKE DR",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716033937",
            "telephone_number": "870-534-1834",
            "fax_number": "870-534-5798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 RIKE DR",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716033937",
            "telephone_number": "870-534-1834",
            "fax_number": "870-534-5798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "MICHELE",
        "middle_name": "L",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-18",
        "last_updated": "2008-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "A01350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116378726",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

Verify at the official NPI Registry.