Provider Demographics
NPI:1437019163
Name:REYNOLDS, SAMUEL MATTHEW
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MATTHEW
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 TABNER MOORE RD
Mailing Address - Street 2:
Mailing Address - City:APPLE GROVE
Mailing Address - State:WV
Mailing Address - Zip Code:25502-8044
Mailing Address - Country:US
Mailing Address - Phone:740-706-4397
Mailing Address - Fax:
Practice Address - Street 1:1273 TABNER MOORE RD
Practice Address - Street 2:
Practice Address - City:APPLE GROVE
Practice Address - State:WV
Practice Address - Zip Code:25502-8044
Practice Address - Country:US
Practice Address - Phone:740-706-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant