Provider Demographics
NPI:1376017657
Name:REYNOLDS, KINSEY (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:KINSEY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 S 500 E
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-8821
Mailing Address - Country:US
Mailing Address - Phone:435-790-3809
Mailing Address - Fax:
Practice Address - Street 1:379 N 500 W
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-1956
Practice Address - Country:US
Practice Address - Phone:435-789-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11111494-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT11111494-1206OtherSTATE OF UTAH ACTIVE LICENSE NUMBER