Basic Information
Provider Information
NPI: 1114305901
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REED
FirstName: SARA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D./PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 CHILDRENS WAY # 844
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722023500
CountryCode: US
TelephoneNumber: 5013642090
FaxNumber: 5013643929
Practice Location
Address1: 2601 GENE GEORGE BLVD
Address2:  
City: SPRINGDALE
State: AR
PostalCode: 72762
CountryCode: US
TelephoneNumber: 4797256801
FaxNumber: 4797256577
Other Information
ProviderEnumerationDate: 05/12/2015
LastUpdateDate: 07/25/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
208000000XE-11080ARY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


Home