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NPI Code Detail

MEDICARE: MRS. AMY LYNN REYNOLDS FNP

MEDICARE: MRS. AMY LYNN REYNOLDS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner2017016291MO
2363LF0000XFamily Nurse Practitioner309004087IL

General Provider Information

NPI Number : 1063650455
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AMY LYNN REYNOLDS FNP
Provider Business Mailing Address
First Line : 211 E HANOVER ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1811
Country : US
Telephone Number : 618-588-2900
Fax Number : 618-588-2904
Provider Business Practice Location Address
First Line : 211 E HANOVER ST
Second Line :
City : NEW BADEN
State : IL
Zip : 62265-1811
Country : US
Telephone Number : 618-588-2900
Fax Number : 618-588-2904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2009
Last Update Date : 11/05/2021

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