Provider Demographics
NPI:1710311279
Name:REYNOLDS, ERIC (NP-C)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1778 E 3500 S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-9236
Mailing Address - Country:US
Mailing Address - Phone:435-789-5735
Mailing Address - Fax:
Practice Address - Street 1:1680 W HIGHWAY 40 STE 201
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4135
Practice Address - Country:US
Practice Address - Phone:801-429-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5669941-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily