Provider Demographics
NPI:1356455174
Name:REYNOLDS, BOBBY DEAN II (FNP)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:DEAN
Last Name:REYNOLDS
Suffix:II
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 W ELK AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2876
Mailing Address - Country:US
Mailing Address - Phone:423-543-6660
Mailing Address - Fax:423-543-5133
Practice Address - Street 1:1503 W ELK AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2876
Practice Address - Country:US
Practice Address - Phone:423-543-6660
Practice Address - Fax:423-543-5133
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509464Medicaid
TN1509464OtherMEDICARE
TN4330448OtherBLUE CROSS BLUE SHIELD