Provider Demographics
NPI:1730680117
Name:REYNOLDS, ALISON LEA (LVN)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:LEA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PRAIRIE WIND
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401
Mailing Address - Country:US
Mailing Address - Phone:956-245-5568
Mailing Address - Fax:
Practice Address - Street 1:208 PRAIRIE WIND
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401
Practice Address - Country:US
Practice Address - Phone:956-245-5568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111903164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111903OtherLVN LICENSE