Ida Pearl Reynolds, P.N.P.

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

243709 Issued in TX

Practice address

618 N Main St
Corsicana, TX 75110-3028

Phone

(903) 872-2151

Fax

(903) 872-7215

NPI assigned

Jun 28, 2006

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Corsicana-Navarro County Public Health District

  • State or Local Public Health Clinic/Center
  • Corsicana, TX
  • NPI 1164467742
  NPD (past)
• Navarro County Ambulatory Care Association

  • Federally Qualified Health Center (FQHC)
  • Corsicana, TX
  • NPI 1124782875
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821026196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 518",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751510518",
            "telephone_number": "903-872-2151",
            "fax_number": "903-872-7215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 N MAIN ST",
            "city": "CORSICANA",
            "state": "TX",
            "postal_code": "751103028",
            "telephone_number": "903-872-2151",
            "fax_number": "903-872-7215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "IDA",
        "middle_name": "PEARL",
        "credential": "P.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "243709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Demetria Reed, DPT
• Regional Employee Assistance Program
• Regional Employee Assistance Program Inc
• Regional Employee Assistance Program Inc
• Restore Dental PLLC
• Johanna Rhodes, OTR
• Richard P Harper, DDS, PHD, PA
• Christopher Blake Richardson, D.D.S.
• Mario P. Ridad
• Merideth Riedel, COTA

• Pediatric Nurse Practitioner in Corsicana, TX
• Providers in Corsicana, TX by specialty
• Pediatric Nurse Practitioner in Texas

• 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.

Verify at the official NPI Registry.