Healthcare Provider Details

I. General information

NPI: 1013780741
Provider Name (Legal Business Name): JOANNA LYN REYNOLDS NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2023
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

1420 TERRI ST
KEYSER WV
26726-2027
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-1111
  • Fax:
Mailing address:
  • Phone: 540-550-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number0024193324
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number117632
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: