MEDICARE: NICOLAS REYES

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1629914478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLAS REYES

Provider Business Mailing Address
First Line	:	3534 GRATIOT ST APT 348
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-2952
Country	:	US
Telephone Number	:	573-818-5184
Fax Number	:

Provider Business Practice Location Address
First Line	:	11133 DUNN RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6163
Country	:	US
Telephone Number	:	314-653-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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11133 DUNN RD STE 2427
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Directions to “ NICOLAS REYES ” Practice Location

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