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General NPI Number Information
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NPI Number | 1639586399
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Entity Type | Individual
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Provider Name | CORA MARIE REYNOLDS ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 3214 TAZEWELL PIKE STE 105
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City | KNOXVILLE
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State | TN
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Zip | 37918-2588
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Country | US
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Telephone | 865-229-4259
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Fax |
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Provider Business Mailing Address
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Address Line | 3214 TAZEWELL PIKE STE 105
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City | KNOXVILLE
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State | TN
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Zip | 37918-2588
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 28084
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1033341
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209.011587
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 205993
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | GAA-NP000480
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License Number State | GA
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