Healthcare Provider Details

I. General information

NPI: 1689592792
Provider Name (Legal Business Name): MR. REGINALD REYNOLDS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 E SKELLY DR
TULSA OK
74105-5913
US

IV. Provider business mailing address

8332 E 120TH PL S
BIXBY OK
74008-2148
US

V. Phone/Fax

Practice location:
  • Phone: 918-728-2228
  • Fax:
Mailing address:
  • Phone: 539-777-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: