Healthcare Provider Details

I. General information

NPI: 1174041735
Provider Name (Legal Business Name): JESSICA NOEL REYNOLDS AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5437 KIETZKE LN
RENO NV
89511-1088
US

IV. Provider business mailing address

825 N GIBSON RD STE 311
HENDERSON NV
89011-1708
US

V. Phone/Fax

Practice location:
  • Phone: 775-322-4550
  • Fax: 775-562-2694
Mailing address:
  • Phone: 702-776-8300
  • Fax: 702-776-8408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPRN002662
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: