Active NPI
Pamela Reynolds, FNPC
- Nurse Practitioner
- South Boston, VA
National Provider Identifier
1932178019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 024164721
- Practice address
- 2212 Wilborn Ave
South Boston, VA 24592-1630 - Phone
- (434) 572-8921
- Fax
- (434) 572-2063
- NPI assigned
- Mar 14, 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 024164721 | VA | Primary |
Addresses
Primary practice location
2212 Wilborn Ave
South Boston, VA 24592-1630
Mailing address
2212 Wilborn Ave
South Boston, VA 24592-1630
Phone (434) 572-8921
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007791992 | Medicaid | VA | |
| 35419N | Other | VA | OPTIMA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110427000726 | VA | Practitioner - Nurse Practitioner | 1456536986 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 024164721 | VA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932178019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2212 WILBORN AVE",
"city": "SOUTH BOSTON",
"state": "VA",
"postal_code": "245921630",
"telephone_number": "434-572-8921",
"fax_number": "434-572-2063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2212 WILBORN AVE",
"city": "SOUTH BOSTON",
"state": "VA",
"postal_code": "245921630",
"telephone_number": "434-572-8921",
"fax_number": "434-572-2063"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "PAMELA",
"credential": "FNPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "VA",
"license": "024164721",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "007791992",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMA",
"identifier": "35419N",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Boston, VA
- Kortney Nicole Puryear, COTA/L
- RB Hughes Drug Inc
- Reflections Behavioral Health Services LLC
- Reliacare Transport LLC
- Renal Care Group of the South, Inc.
- Tameca Rashaun Richardson, QMHP, CSAC-A, PMP
- Markeisha Lashay Roberts
- Maurice J Roberts, FNP-C
- Hannah Lona Robertson, M.A., CCC-SLP
- Jamie Robinette
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.