Healthcare Provider Details

I. General information

NPI: 1881478964
Provider Name (Legal Business Name): ISABELLA FAITH REYNOLDS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S WHEELING AVE STE 100
TULSA OK
74104-5643
US

IV. Provider business mailing address

1923 S UTICA AVE
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-403-7070
  • Fax: 918-403-6327
Mailing address:
  • Phone: 918-403-7070
  • Fax: 918-403-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5709
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: