Provider Demographics
NPI:1528636859
Name:REYNOLDS, BRIAN JOSEPH (APNP/NP)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:APNP/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7619 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-1519
Mailing Address - Country:US
Mailing Address - Phone:262-234-7393
Mailing Address - Fax:262-393-2529
Practice Address - Street 1:2363 S 102ND ST STE 201
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2143
Practice Address - Country:US
Practice Address - Phone:262-999-7350
Practice Address - Fax:262-393-2529
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI11003363LP0808X
WI11003-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health