Healthcare Provider Details

I. General information

NPI: 1821563768
Provider Name (Legal Business Name): SHARON E REYNOLDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 CARMICHAEL RD
MONTGOMERY AL
36106-2803
US

IV. Provider business mailing address

4145 CARMICHAEL RD
MONTGOMERY AL
36106-2803
US

V. Phone/Fax

Practice location:
  • Phone: 334-273-7000
  • Fax:
Mailing address:
  • Phone: 334-273-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-130363
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-130363
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: