Active NPI
Colleen Reynolds, PA-C
- Physician Assistant
- Shickshinny, PA
National Provider Identifier
1750450037
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA002172L
- Practice address
- 26 N Main St
Shickshinny Health Center
Shickshinny, PA 18655-1302 - Phone
- (570) 542-4141
- Fax
- (570) 542-2580
- NPI assigned
- Nov 8, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA002172L | PA | Primary |
Addresses
Primary practice location
26 N Main St
Shickshinny Health Center
Shickshinny, PA 18655-1302
Mailing address
1084 Route 315
Wilkes-Barre, PA 18702-7012
Phone (570) 825-8741
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 |
|---|---|---|---|
| MA002172L | PA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750450037",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1084 ROUTE 315",
"city": "WILKES-BARRE",
"state": "PA",
"postal_code": "187027012",
"telephone_number": "570-825-8741",
"fax_number": "570-825-8990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26 N MAIN ST",
"address_2": "SHICKSHINNY HEALTH CENTER",
"city": "SHICKSHINNY",
"state": "PA",
"postal_code": "186551302",
"telephone_number": "570-542-4141",
"fax_number": "570-542-2580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "COLLEEN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA002172L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shickshinny, PA
- Neighborhood Family Medicine
- Northwest Area School District
- Megan M O'Donovan, PA-C
- Rebecca Pawlik, R.D.,L.D.N.
- Pennsylvania CVS Pharmacy, L.L.C.
- Rural Health Corporation of Northeastern Pennsylvania
- Shickshinny Area Volunteer Ambulance Assoc Inc
- Leanne C Smith, DC
- Jurgen Straub, MD
- Transformations Counseling and Emdr Services
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.