Active NPI
Jennifer McReynolds, ST
- Speech-Language Pathologist
- Keller, TX
National Provider Identifier
1447474309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 100182
- Practice address
- 4701 Eagle Trace Dr
Keller, TX 76248-7960 - Phone
- (817) 706-9294
- NPI assigned
- Apr 12, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 100182 | TX | Primary |
Addresses
Primary practice location
4701 Eagle Trace Dr
Keller, TX 76248-7960
Mailing address
4701 Eagle Trace Dr
Keller, TX 76248-7960
Phone (817) 706-9294
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100182 | Other | TX | STATE LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100182 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447474309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4701 EAGLE TRACE DR",
"city": "KELLER",
"state": "TX",
"postal_code": "762487960",
"telephone_number": "817-706-9294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4701 EAGLE TRACE DR",
"city": "KELLER",
"state": "TX",
"postal_code": "762487960",
"telephone_number": "817-706-9294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCREYNOLDS",
"first_name": "JENNIFER",
"credential": "ST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TX",
"license": "100182",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "100182",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Keller, TX
Sources for this page
- 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.