| Doctor Name: | REGGIE MICHAEL GILLINS |
| NPI Number: | 1619311974 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | TAP4963 |
| Business Practice Address: | 355 N Main St Kanab, UT - 847413260 |
| Business Phone Number: | 4356444100 |
| Business Fax Number: | 4356443366 |
| Mailing Address: | 1055 N 500 W, PROVO |
| State: | UT |
| Postal Code: | 846043305 |
| Phone Number: | 4356444100 |
| Fax Number: | 4356443366 |
| NPI Enumeration Date: | 04/17/2013 |
| NPI Last Update Date: | 08/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | TAP4963 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |