Provider Demographics
NPI:1982418984
Name:VILLINES, REAGAN (PMHNP)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:VILLINES
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WESTCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-7743
Mailing Address - Country:US
Mailing Address - Phone:501-414-6446
Mailing Address - Fax:
Practice Address - Street 1:720 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4738
Practice Address - Country:US
Practice Address - Phone:479-910-3169
Practice Address - Fax:479-600-5051
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR231939363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR335745758Medicaid