Healthcare Provider Details

I. General information

NPI: 1629597893
Provider Name (Legal Business Name): ANJELENE REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BRYANT WILLIAMS DR STE 1
KLAMATH FALLS OR
97601-1121
US

IV. Provider business mailing address

1307 LATIGO DR
HENDERSON NV
89002-3650
US

V. Phone/Fax

Practice location:
  • Phone: 541-884-7746
  • Fax:
Mailing address:
  • Phone: 406-381-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: