Provider Demographics
NPI:1174041735
Name:REYNOLDS, JESSICA NOEL (AGCNS-BC)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:NOEL
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6989 EMERALD SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1366
Mailing Address - Country:US
Mailing Address - Phone:916-390-2296
Mailing Address - Fax:
Practice Address - Street 1:6240 N DURANGO DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3941
Practice Address - Country:US
Practice Address - Phone:954-923-7440
Practice Address - Fax:954-923-1299
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN002662364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health