Reynolds, Derek John

Reynolds, Derek John is an individual health care provider with primary practice located at Saint Regis Mohawk Tribe Health Services 404 State Route 37, Hogansburg NY 13655-3109. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Reynolds, Derek John can be contacted via phone (518) 358-3141.

Contact Information

Primary practice address
Saint Regis Mohawk Tribe Health Services 404 State Route 37 Hogansburg NY 13655-3109
Phone: (518) 358-3141
Fax: (518) 358-9175
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X F338090-1 New York

Profile Details

NPI number 1285074054
LBN Legal business name Reynolds, Derek John
Credentials FNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 26th, 2013
Last updated Mar 30th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285074054 NPPES
New York MEDICAID 03619812

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