Healthcare Provider Details

I. General information

NPI: 1427454438
Provider Name (Legal Business Name): MELINDA BROWN REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 W 100 S
ST GEORGE UT
84770-3355
US

IV. Provider business mailing address

132 W 100 S
ST GEORGE UT
84770-3355
US

V. Phone/Fax

Practice location:
  • Phone: 801-907-0307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51963
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60865722
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9180092-8906
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: