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General NPI Number Information
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NPI Number | 1528636859
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Entity Type | Individual
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Provider Name | BRIAN JOSEPH REYNOLDS APNP/NP
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Gender | Male
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 09/07/2025
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Provider Practice Location Address
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Address Line | 2363 S 102ND ST STE 201
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City | WEST ALLIS
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State | WI
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Zip | 53227-2143
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Country | US
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Telephone | 262-999-7350
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Fax | 262-393-2529
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Provider Business Mailing Address
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Address Line | 7619 SHERIDAN RD
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City | KENOSHA
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State | WI
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Zip | 53143-1519
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Country | US
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Telephone | 262-234-7393
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Fax | 262-393-2529
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11003
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11003-33
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License Number State | WI
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