Provider Demographics
NPI:1548934409
Name:REYNOLDS, BETTY JO (APRN-C)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:JO
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 MIRACLE DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4600
Mailing Address - Country:US
Mailing Address - Phone:307-267-5354
Mailing Address - Fax:
Practice Address - Street 1:1715 MIRACLE DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4600
Practice Address - Country:US
Practice Address - Phone:307-267-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY47567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily