Basic Information
| Provider Information | |||||||||
| NPI: | 1679688188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3603 PINE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357696462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562183070 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 508 GREGORY ST | ||||||||
| Address2: | |||||||||
| City: | SCOTTSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357684239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562561774 | ||||||||
| FaxNumber: | 2562590761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1-031100 | AL | X | Nursing Service Providers | Registered Nurse | 163WP0807X | 1-031100 | AL | X | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 163WP0808X | 1-031100 | AL | X | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 163WP0809X | 1-031100 | AL | X | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 163WA0400X | 1-031100 | AL | X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 51531383 | 01 | AL | BCBS | OTHER |