Healthcare Provider Details

I. General information

NPI: 1609425339
Provider Name (Legal Business Name): LINDSEY B MCREYNOLDS APRN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date: 05/10/2021
Reactivation Date: 06/18/2021

III. Provider practice location address

912 BURNETT ST
WICHITA FALLS TX
76301-3208
US

IV. Provider business mailing address

1403 OAKRIDGE RD
ARDMORE OK
73401-3611
US

V. Phone/Fax

Practice location:
  • Phone: 940-285-5052
  • Fax:
Mailing address:
  • Phone: 580-319-8425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0099595
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-51363
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1036634
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNMO6943
License Number State
# 5
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1036634
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: