Healthcare Provider Details

I. General information

NPI: 1710311279
Provider Name (Legal Business Name): ERIC REYNOLDS NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2013
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 W HIGHWAY 40 STE 201
VERNAL UT
84078-4135
US

IV. Provider business mailing address

589 S STATE ST
PROVO UT
84606-5056
US

V. Phone/Fax

Practice location:
  • Phone: 801-429-2000
  • Fax:
Mailing address:
  • Phone: 801-420-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5669941-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: