Heather Reynolds, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

352929-1206 Issued in UT

Practice address

3705 N 6100 W
Ivins, UT 84738

Phone

(435) 688-8198

NPI assigned

Oct 24, 2014

Last updated

Jan 10, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2025 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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

• Paiute Indian Tribe of Utah

  dba Shivwits Medical Clinic

  • Prosthetic/Orthotic Supplier
  • Ivins, UT
  • NPI 1558590539
  NPD (past)

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

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578614400000",
    "number": "1447655063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 W 23RD ST FL 5",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100105240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 N 6100 W",
            "city": "IVINS",
            "state": "UT",
            "postal_code": "84738",
            "telephone_number": "435-688-8198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "HEATHER",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-24",
        "last_updated": "2020-01-10",
        "certification_date": "2020-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "352929-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paiute Indian Tribe of Utah (Shivwits Medical Clinic)
• Rachelle Catherine Perry
• Curtis Peters
• Nita Louise Randall, R.N.
• Red Mountain Mental Health
• Drew D Richards, DDS
• Nicholas Saidi
• Brogan R Secrist
• Addie Re Smith-Rakisits
• Brittany Smith

• Medical Physician Assistant in Ivins, UT
• Providers in Ivins, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.