Provider Demographics
NPI:1538997978
Name:REYNOLDS, KEVIN RAY
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RAY
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 1:2991 RODEO DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-1080
Mailing Address - Country:US
Mailing Address - Phone:918-706-1984
Mailing Address - Fax:
Practice Address - Street 1:2991 RODEO DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-1080
Practice Address - Country:US
Practice Address - Phone:918-706-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist