Healthcare Provider Details

I. General information

NPI: 1174609101
Provider Name (Legal Business Name): REYNOLD LEE MOSIER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

V. Phone/Fax

Practice location:
  • Phone: 785-240-7501
  • Fax: 857-239-7438
Mailing address:
  • Phone: 785-240-7227
  • Fax: 785-240-7438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110279
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: