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General NPI Number Information
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NPI Number | 1518552090
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Entity Type | Individual
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Provider Name | WHITNEY J REARDON FNP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 1107 S MAIN ST
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City | REIDSVILLE
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State | NC
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Zip | 27320-5313
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Country | US
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Telephone | 336-951-6070
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Fax |
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Provider Business Mailing Address
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Address Line | 5930 APPLE WYRICK RD
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City | GIBSONVILLE
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State | NC
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Zip | 27249-8843
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Country | US
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Telephone | 336-552-5291
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Fax |
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 5014180
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5014180
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | REAR-Z5J8E
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License Number State | NC
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