Active NPI
Jannelle Gwyneth Reynolds, PA-C
- Physician Assistant
- Kearney, NE
National Provider Identifier
1497073811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 2510 11TH Ave
Kearney, NE 68849-2247 - Phone
- (970) 214-3570
- NPI assigned
- May 10, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA20862 | CA | |
| Physician Assistant | 363A00000X | 15-01382 | KS | |
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
2510 11TH Ave
Kearney, NE 68849-2247
Mailing address
2402 Univeristy Dr
Kearney, NE 68849-2217
Phone (970) 214-3570
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA20862 | CA | MD | Physician Assistant |
| 15-01382 | KS | MD | Physician Assistant |
Interoperability endpoints
- jannelle.reynolds.1@16664.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273449600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565049600000",
"number": "1497073811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2402 UNIVERISTY DR",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688492217",
"telephone_number": "970-214-3570"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2510 11TH AVE",
"city": "KEARNEY",
"state": "NE",
"postal_code": "688492247",
"telephone_number": "970-214-3570"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "JANNELLE",
"middle_name": "GWYNETH",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-10",
"last_updated": "2019-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA20862",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "KS",
"license": "15-01382",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kearney, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.