Provider Demographics
NPI:1134932742
Name:REYNOLDS, COURTNEY LYNNE
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LYNNE
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 1:253 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:MOORCROFT
Mailing Address - State:WY
Mailing Address - Zip Code:82721-8717
Mailing Address - Country:US
Mailing Address - Phone:307-756-2079
Mailing Address - Fax:
Practice Address - Street 1:253 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:MOORCROFT
Practice Address - State:WY
Practice Address - Zip Code:82721-8717
Practice Address - Country:US
Practice Address - Phone:307-756-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator