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General NPI Number Information
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NPI Number | 1285074054
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Entity Type | Individual
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Provider Name | DEREK JOHN REYNOLDS FNP-C
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Gender | Male
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | SAINT REGIS MOHAWK TRIBE HEALTH SERVICES 404 STATE ROUTE 37
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City | HOGANSBURG
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State | NY
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Zip | 13655-3109
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Country | US
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Telephone | 518-358-3141
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Fax | 518-358-9175
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Provider Business Mailing Address
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Address Line | SAINT REGIS MOHAWK TRIBE HEALTH SERVICES 404 STATE ROUTE 37
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City | HOGANSBURG
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State | NY
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Zip | 13655-3109
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Country | US
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Telephone | 518-358-3141
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Fax | 518-358-9175
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F338090-1
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License Number State | NY
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