Individual provider Active NPI

Sylvia M Reynoso, AGNP-C

  • Gerontology Nurse Practitioner
  • Harlingen, TX
National Provider Identifier
1417664442
Registry record updated May 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
1096579 Issued in TX
Practice address
629 Kamali Dr
Harlingen, TX 78550-0016
Phone
(956) 425-7800
Fax
(956) 425-7801
NPI assigned
Oct 31, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 1096579 TX Primary

Addresses

Primary practice location

629 Kamali Dr
Harlingen, TX 78550-0016

Mailing address

629 Kamali Dr
Harlingen, TX 78550-0016
Phone (956) 425-7800

Other identifiers 1

IdentifierTypeStateIssuer
1096579OtherTXTEXAS STATE LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL EOI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20221209000815 TX Practitioner - Nurse Practitioner 0749659902 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
1096579TXMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Luis Reynoso PA CurrentSince Nov 1, 2022 Accepting new patients

Locations

2401 N Ed Carey Dr
Ste C
Harlingen, TX 78550
Phone (956) 425-7800

629 Kamali Dr
Harlingen, TX 78550
Phone (956) 425-7800

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777852800000",
    "number": "1417664442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 KAMALI DR",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785500016",
            "telephone_number": "956-425-7800",
            "fax_number": "956-425-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 KAMALI DR",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785500016",
            "telephone_number": "956-425-7800",
            "fax_number": "956-425-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOSO",
        "first_name": "SYLVIA",
        "middle_name": "M",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-31",
        "last_updated": "2026-05-04",
        "certification_date": "2026-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "1096579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE LICENSE",
            "identifier": "1096579",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "EOI",
            "affiliation": "N",
            "endpointDescription": "eclinicalworks",
            "address_1": "629 Kamali Dr",
            "city": "Harlingen",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785500016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Harlingen, TX

Sources for this page

Verify at the official NPI Registry.