Reynolds, Derek John
Reynolds, Derek John is an individual health care provider with primary practice located at Saint Regis Mohawk Tribe Health Services 404 State Route 37, Hogansburg NY 13655-3109. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Reynolds, Derek John can be contacted via phone (518) 358-3141.Contact Information
Primary practice address
Saint Regis Mohawk Tribe Health Services 404 State Route 37
Hogansburg NY 13655-3109
Phone: (518) 358-3141
Fax: (518) 358-9175
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | F338090-1 | New York |
Profile Details
| NPI number | 1285074054 |
|---|---|
| LBN Legal business name | Reynolds, Derek John |
| Credentials | FNP-C |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 26th, 2013 |
| Last updated | Mar 30th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285074054 | NPPES |
| New York | MEDICAID | 03619812 |
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