Provider Demographics
NPI:1639958226
Name:REYNOLDS, NICOLE A (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:820 BUFFALO SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8470
Mailing Address - Country:US
Mailing Address - Phone:703-945-5039
Mailing Address - Fax:
Practice Address - Street 1:820 BUFFALO SPRINGS DR
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8470
Practice Address - Country:US
Practice Address - Phone:703-945-5039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse