Healthcare Provider Details

I. General information

NPI: 1457282873
Provider Name (Legal Business Name): YVANNA RAE REYES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2639
US

IV. Provider business mailing address

1288 SOUTHPORT CIR
COLUMBUS OH
43235-7642
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-3250
  • Fax:
Mailing address:
  • Phone: 510-386-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: