Healthcare Provider Details

I. General information

NPI: 1841185311
Provider Name (Legal Business Name): FAITH NATASHA REYNOLDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 W 32ND ST STE 401
JOPLIN MO
64804-1646
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7009
  • Fax: 417-347-3288
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2025021369
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: