Provider Demographics
NPI:1457459034
Name:REYNOLDS, JUDITH ANN (CPNP, MSN)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CPNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 VALLEYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-8130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1602 SW 82ND ST
Practice Address - Street 2:SOUTHWESTERN BEH HLTH CTR
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9012
Practice Address - Country:US
Practice Address - Phone:580-536-0077
Practice Address - Fax:580-510-2778
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0054436363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK593814Medicare UPIN