Provider Demographics
NPI:1881218972
Name:REINHARDT, JESSICA MARIE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 REYNOLDS WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1586
Mailing Address - Country:US
Mailing Address - Phone:937-485-9401
Mailing Address - Fax:910-775-9165
Practice Address - Street 1:1 REYNOLDS WAY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45430-1586
Practice Address - Country:US
Practice Address - Phone:937-485-9401
Practice Address - Fax:910-227-2847
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1881218972Medicaid