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General NPI Number Information
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NPI Number | 1902958697
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Entity Type | Individual
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Provider Name | ELENA TERECE REYNOLDS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 2053 VALLEYGATE DR SUITE 101
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3747
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Country | US
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Telephone | 910-323-9222
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Fax | 910-223-9783
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Provider Business Mailing Address
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Address Line | 2149 VALLEYGATE DR STE 101
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3666
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Country | US
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Telephone | 910-670-0207
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-00804
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License Number State | NC
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