Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 502136 | TX |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 502136 | TX |
NPI | 1205868411 |
---|---|
Provider Name | Kimberly Reynolds |
First Address | Amarillo, TX 79106-1708 |
Second Address | Amarillo, TX 79106-1786 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 27/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
096183102 | (05) | TX |
096183103 | (05) | TX |
200061520 A | (05) | OK |
55522386 | (05) | NM |
S85703 | (02) |