Individual provider · Type 1 NPI
Ricco Cory Reynolds, FNP-C
Family Nurse Practitioner · Portland, OR
NPI number
1205435997
Active
Practice location
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Athletic Trainer | 2255A2300X | None listed |
| Family Nurse Practitioner | 363LF0000X | API61363661 (WA) |
| Student in an Organized Health Care Education/Training Program | 390200000X | None listed |
| Family Nurse Practitioner Primary | 363LF0000X | 202213334NP-PP (OR) |
Family Nurse Practitioner: Definition to come...
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About NPI 1205435997
Ricco Cory Reynolds, FNP-C's National Provider Identifier is 1205435997, issued on Oct 22, 2020. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Portland, OR. The record was last updated on Oct 26, 2022.