Mac Patrik Reynolds, BS. PSYCHOLOGY

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Practice address

620 W Prosser Rd Lot H
Cheyenne, WY 82007-3054

Phone

(307) 274-6567

NPI assigned

Sep 28, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1013524628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 W PROSSER RD LOT H",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820073054",
            "telephone_number": "307-274-6567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W PROSSER RD LOT H",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820073054",
            "telephone_number": "307-274-6567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "MAC",
        "middle_name": "PATRIK",
        "name_prefix": "Mr.",
        "credential": "BS. PSYCHOLOGY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "WY",
            "license": null,
            "primary": false
        },
        {
            "code": "372600000X",
            "taxonomy_group": "",
            "desc": "Adult Companion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "WY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melanie Rene Reuer, RN
• Gilberto Revuelta
• Beatriz Reyes, PHARMD
• Abraham Gerald Reynolds, PH.D.
• David L. Reynolds, RRT
• Todd E Reynolds, MSW, LAT
• Destiny Rhoden
• Rasha Mohamed Riad, APRN, FNP-C
• Gena Megan Ribucan-Juarez, RN
• Charla Ricciardi

• Developmentally Disabled Services Day Training Agency in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Developmentally Disabled Services Day Training Agency in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.