Provider Demographics
NPI:1518625391
Name:REYNOLDS, EMILY GABRIELLE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:GABRIELLE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:GABRIELLE
Other - Last Name:RISCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:2244 BUNKER HILL CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2922
Mailing Address - Country:US
Mailing Address - Phone:405-664-8704
Mailing Address - Fax:
Practice Address - Street 1:2701 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-0174
Practice Address - Country:US
Practice Address - Phone:940-222-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85512133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered