Mary Katherine Reynolds, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

A438 Issued in SC

Practice address

1205 N Highway 11
West Union, SC 29696-2715

Phone

(864) 638-5402

Fax

(864) 638-6126

NPI assigned

Apr 19, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Golden Corner Family Prac

  • Family Medicine Physician
  • West Union, SC
  • NPI 1184771321
  Medicare reassignment
• Booker Family Practice, LLC

  • Family Medicine Physician
  • West Union, SC
  • NPI 1871413468
  NPD (past)

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244592000000",
    "number": "1417174673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 219",
            "city": "WEST UNION",
            "state": "SC",
            "postal_code": "296960219",
            "telephone_number": "864-638-5402",
            "fax_number": "864-638-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 N HIGHWAY 11",
            "city": "WEST UNION",
            "state": "SC",
            "postal_code": "296962715",
            "telephone_number": "864-638-5402",
            "fax_number": "864-638-6126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "MARY",
        "middle_name": "KATHERINE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-19",
        "last_updated": "2009-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "A438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oconee Dental Associates,LLC
• Kenneth David Parker, DMD
• Jeffrey Wayne Pierce, P.T.
• Cesar Ramirez, DPT
• Stephanie Rayner
• Rosa Clark Medical Clinic Association, Inc.
• Adam Frederick Schwartz, DMD
• Amanda Lee Simpson, PHARMD
• South Carolina CVS Pharmacy LLC
• Marie Maude Sussman, NP

• Physician Assistant in West Union, SC
• Providers in West Union, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.