Provider Demographics
NPI:1922713890
Name:REYNOLDS, PENNY JO
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:JO
Last Name:REYNOLDS
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 1:2179 HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-3318
Mailing Address - Country:US
Mailing Address - Phone:405-343-6181
Mailing Address - Fax:
Practice Address - Street 1:2179 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-3318
Practice Address - Country:US
Practice Address - Phone:405-343-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist