Provider Demographics
NPI:1558964221
Name:REYNOLDS, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12761 S CALHOUN HWY
Mailing Address - Street 2:
Mailing Address - City:ARNOLDSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25234-8019
Mailing Address - Country:US
Mailing Address - Phone:304-531-8177
Mailing Address - Fax:
Practice Address - Street 1:12761 S CALHOUN HWY
Practice Address - Street 2:
Practice Address - City:ARNOLDSBURG
Practice Address - State:WV
Practice Address - Zip Code:25234-8019
Practice Address - Country:US
Practice Address - Phone:304-531-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant