Provider Demographics
NPI:1306493622
Name:REYNOLDS, PAUL STEVEN
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:STEVEN
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 E 12TH AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3434
Mailing Address - Country:US
Mailing Address - Phone:720-593-8989
Mailing Address - Fax:
Practice Address - Street 1:3570 E 12TH AVE
Practice Address - Street 2:STE 203
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-3434
Practice Address - Country:US
Practice Address - Phone:720-593-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994891-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily