Provider Demographics
NPI:1205655685
Name:REYNOLDS, JESSICA LEIGHANN (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEIGHANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 DOANE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SALTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24370-4381
Mailing Address - Country:US
Mailing Address - Phone:276-780-4564
Mailing Address - Fax:
Practice Address - Street 1:350 DOANE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:SALTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24370-4381
Practice Address - Country:US
Practice Address - Phone:276-780-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001209448163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice