Healthcare Provider Details

I. General information

NPI: 1356018550
Provider Name (Legal Business Name): MELISSA ANN REYNOSO MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 08/14/2022
Certification Date: 08/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 18TH ST
BAKERSFIELD CA
93301-4205
US

IV. Provider business mailing address

7905 KIMBERLY AVE
BAKERSFIELD CA
93308-3634
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-9693
  • Fax: 661-327-0749
Mailing address:
  • Phone: 661-472-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021233
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: