Provider Demographics
NPI:1609425339
Name:MCREYNOLDS, LINDSEY B (APRN-CNM)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:B
Last Name:MCREYNOLDS
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-3611
Mailing Address - Country:US
Mailing Address - Phone:580-319-8425
Mailing Address - Fax:
Practice Address - Street 1:912 BURNETT ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3208
Practice Address - Country:US
Practice Address - Phone:940-285-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2021-06-23
Deactivation Date:2021-05-10
Deactivation Code:
Reactivation Date:2021-06-18
Provider Licenses
StateLicense IDTaxonomies
OKR0099595163W00000X
OKL-51363163WL0100X
TX1036634363L00000X, 367A00000X
CNMO6943367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner