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General NPI Number Information
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NPI Number | 1619606043
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Entity Type | Individual
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Provider Name | JESSICA REYNEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 2323 S 171ST ST STE 100A
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City | OMAHA
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State | NE
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Zip | 68130-4651
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Country | US
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Telephone | 531-710-4063
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Fax | 531-721-2946
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Provider Business Mailing Address
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Address Line | 2323 S 171ST ST STE 100
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City | OMAHA
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State | NE
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Zip | 68130-4651
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2766
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License Number State | NE
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