Provider Demographics
NPI:1457504359
Name:REYNOLDS, GRETCHEN KLINGLER (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:KLINGLER
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MISS
Other - First Name:GRETCHEN
Other - Middle Name:LYNNE
Other - Last Name:KLINGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:806 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PARKESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19365-1304
Mailing Address - Country:US
Mailing Address - Phone:610-857-0178
Mailing Address - Fax:
Practice Address - Street 1:1625 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4335
Practice Address - Country:US
Practice Address - Phone:717-925-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000640363AM0700X
PAMA053513363AM0700X
PAOA002660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant