Active NPI
Jesse Reynolds, PA-C
- Physician Assistant
- Tacoma, WA
National Provider Identifier
1639140197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- Madigan Army Medical Center
9040 Jackson, Ave
Tacoma, WA 98431 - Phone
- (253) 967-7656
- NPI assigned
- Jan 31, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
Madigan Army Medical Center
9040 Jackson, Ave
Tacoma, WA 98431
Mailing address
Madigan Army Medical Center
9040 Jackson Ave
Joint Base Lewis-McChord, WA 98431
Phone (912) 368-3375
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA60698388 | Other | WA | PA LICENSE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709683200000",
"number": "1639140197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MADIGAN ARMY MEDICAL CENTER",
"address_2": "9040 JACKSON AVE",
"city": "JOINT BASE LEWIS-MCCHORD",
"state": "WA",
"postal_code": "98431",
"telephone_number": "912-368-3375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "MADIGAN ARMY MEDICAL CENTER",
"address_2": "9040 JACKSON, AVE",
"city": "TACOMA",
"state": "WA",
"postal_code": "98431",
"telephone_number": "253-967-7656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "JESSE",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2024-03-06",
"certification_date": "2024-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE",
"identifier": "PA60698388",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.