Provider Demographics
NPI:1437488905
Name:REYNOLDS, KERRY (CD)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 CALICO POOL LN
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3706
Mailing Address - Country:US
Mailing Address - Phone:703-855-1938
Mailing Address - Fax:
Practice Address - Street 1:6125 CALICO POOL LN
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3706
Practice Address - Country:US
Practice Address - Phone:703-855-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula