Individual
MRS. JENNIFER A. REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-7738
Mailing address
127 S 500 E STE 600, SALT LAKE CITY, UT 84102-1971
(801) 587-6336
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA18560
CA
363AS0400X
Surgical Physician Assistant
Primary
112011-8926
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA18560
PA LICENSE
CA
Enumeration date
11/08/2006
Last updated
11/15/2021
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