Provider Demographics
NPI:1649633967
Name:REYNOLDS, SUREE
Entity type:Individual
Prefix:MRS
First Name:SUREE
Middle Name:
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 1:8000 HIGHWAY 242
Mailing Address - Street 2:STE 116
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-4342
Mailing Address - Country:US
Mailing Address - Phone:936-242-1627
Mailing Address - Fax:936-242-1312
Practice Address - Street 1:8000 HIGHWAY 242
Practice Address - Street 2:STE 116
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-4342
Practice Address - Country:US
Practice Address - Phone:936-242-1627
Practice Address - Fax:936-242-1312
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130655363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily