Provider Demographics
NPI:1619749140
Name:REYNOLDS, MIKAYLA QUINN (PA-C)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:QUINN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 IDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9027
Mailing Address - Country:US
Mailing Address - Phone:570-954-4506
Mailing Address - Fax:
Practice Address - Street 1:428 S 7TH ST STE 4
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1818
Practice Address - Country:US
Practice Address - Phone:610-824-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065172363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical