Randal David Reynolds, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

00993 Issued in IA

Practice address

4401 Westown Pkwy
Suite 309
West Des Moines, IA 50266-6721

Phone

(515) 440-3801

Fax

(515) 440-3701

NPI assigned

Jul 19, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063431872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 WESTOWN PKWY",
            "address_2": "SUITE 309",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502666721",
            "telephone_number": "515-440-3801",
            "fax_number": "515-440-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 WESTOWN PKWY",
            "address_2": "SUITE 309",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "502666721",
            "telephone_number": "515-440-3801",
            "fax_number": "515-440-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "RANDAL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IA",
            "license": "00993",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0467068",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Revitalize LLC
• Jessica D Reyes
• Kimberly Reyes
• Ramon Santiago Reyes, M.D.
• Joel Steven Reynolds, D.D.S.
• Steven Thomas Reynolds, DDS,MS
• Susan Rhyan, PA-C
• Heather Renee Rice, CADC
• Justin Chad Rice, MD
• Curtis Rich, LISW

• Clinical Psychologist in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Clinical Psychologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.