Provider Demographics
NPI:1881478964
Name:REYNOLDS, ISABELLA FAITH (PA)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:FAITH
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1923 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-403-7070
Mailing Address - Fax:918-403-6327
Practice Address - Street 1:2000 S WHEELING AVE STE 100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5643
Practice Address - Country:US
Practice Address - Phone:918-403-7070
Practice Address - Fax:918-403-6327
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5709363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant