Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 209013822 | IL |
N | 363LA2200X | Nurse Practitioner - Adult Health | 2015043764 | MO |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 2015043764 | MO |
N | 363LP2300X | Nurse Practitioner - Primary Care | 2015043764 | MO |
NPI | 1033572938 |
---|---|
Provider Name | Melissa L Reynolds |
First Address | Hannibal, MO 63401-6890 |
Second Address | Hannibal, MO 63401-6890 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2016 |
Last Update Date | 06/03/2017 |