Doctor Name: | MR. BOBBY DEAN REYNOLDS |
NPI Number: | 1356455174 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | APN0000007649 |
Business Practice Address: | 1503 W Elk Ave Elizabethton, TN - 376432876 |
Business Phone Number: | 4235436660 |
Business Fax Number: | 4235435133 |
Mailing Address: | 1503 W Elk Ave, ELIZABETHTON |
State: | TN |
Postal Code: | 376432876 |
Phone Number: | 4235436660 |
Fax Number: | 4235435133 |
NPI Enumeration Date: | 08/18/2006 |
NPI Last Update Date: | 01/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | APN0000007649 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |