Provider Demographics
NPI:1801959259
Name:REYNOLDS, WHITNEY L (PA)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:1215 21ST AVE S
Mailing Address - Street 2:MCE 5TH FLOOR, SOUTH TOWER, SUITE 5209
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0014
Mailing Address - Country:US
Mailing Address - Phone:615-322-2318
Mailing Address - Fax:615-936-1711
Practice Address - Street 1:1215 21ST AVE S
Practice Address - Street 2:MCE 5TH FLOOR, SOUTH TOWER, SUITE 5209
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0014
Practice Address - Country:US
Practice Address - Phone:615-322-2318
Practice Address - Fax:615-936-1711
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1284363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4167841OtherBCBST
TNCK4255Medicare PIN
TN4167841OtherBCBST
TN3379860Medicare PIN
TNQ52034Medicare UPIN