Provider Demographics
NPI:1922836626
Name:REYNOLDS, SIERRA (LSW)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 JENKINS RUN RD
Mailing Address - Street 2:
Mailing Address - City:MOOREFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:26836-8595
Mailing Address - Country:US
Mailing Address - Phone:304-851-2371
Mailing Address - Fax:
Practice Address - Street 1:1702 JENKINS RUN RD
Practice Address - Street 2:
Practice Address - City:MOOREFIELD
Practice Address - State:WV
Practice Address - Zip Code:26836-8595
Practice Address - Country:US
Practice Address - Phone:304-851-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00946333171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator