Provider Demographics
NPI:1871573915
Name:REYNOLDS, DEANN (PA-C)
Entity type:Individual
Prefix:
First Name:DEANN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6703
Mailing Address - Country:US
Mailing Address - Phone:775-352-7200
Mailing Address - Fax:775-352-7222
Practice Address - Street 1:3160 VISTA BLVD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6703
Practice Address - Country:US
Practice Address - Phone:775-352-7200
Practice Address - Fax:775-352-7222
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002410026Medicaid
NV002410026Medicaid