Provider Demographics
NPI:1295006047
Name:REYNOLDS, BRENDA FAYE (LVN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:FAYE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-7436
Mailing Address - Country:US
Mailing Address - Phone:931-216-3904
Mailing Address - Fax:
Practice Address - Street 1:1773 RIVER RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-7436
Practice Address - Country:US
Practice Address - Phone:931-216-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000040908164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse