Provider Demographics
NPI:1649933979
Name:REYES, PAULA CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:CHRISTINE
Last Name:REYES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 PHYSICIANS DR NW STE 103
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-4216
Mailing Address - Country:US
Mailing Address - Phone:910-794-5355
Mailing Address - Fax:
Practice Address - Street 1:58 PHYSICIANS DR NW STE 103
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4216
Practice Address - Country:US
Practice Address - Phone:910-794-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11964363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant