Provider Demographics
NPI:1629100631
Name:REYNOLDS, PRISCILLA ALDEN (RN, FNP)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:ALDEN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3457 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-5612
Mailing Address - Country:US
Mailing Address - Phone:845-687-4208
Mailing Address - Fax:845-687-4207
Practice Address - Street 1:3457 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5612
Practice Address - Country:US
Practice Address - Phone:845-687-4208
Practice Address - Fax:845-687-4207
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330350-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily