Provider Demographics
NPI:1588335962
Name:REYNOLDS, JOE L (ANP)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:L
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1090
Mailing Address - Country:US
Mailing Address - Phone:843-857-0111
Mailing Address - Fax:843-857-0206
Practice Address - Street 1:737 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SOCIETY HILL
Practice Address - State:SC
Practice Address - Zip Code:29593-8972
Practice Address - Country:US
Practice Address - Phone:843-378-4501
Practice Address - Fax:843-378-4209
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2022-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC25420363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health