Healthcare Provider Details

I. General information

NPI: 1902958697
Provider Name (Legal Business Name): ELENA TERECE REYNOLDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2053 VALLEYGATE DR SUITE 101
FAYETTEVILLE NC
28304-3747
US

IV. Provider business mailing address

2149 VALLEYGATE DR STE 101
FAYETTEVILLE NC
28304-3666
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-9222
  • Fax: 910-223-9783
Mailing address:
  • Phone: 910-670-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-00804
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-00804
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: