Provider Demographics
NPI:1578692786
Name:REYNOLDS, KATHERINE LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:LYNN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510-0768
Mailing Address - Country:US
Mailing Address - Phone:928-725-2314
Mailing Address - Fax:928-725-2370
Practice Address - Street 1:1 MILE N HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510-8651
Practice Address - Country:US
Practice Address - Phone:928-725-2314
Practice Address - Fax:928-725-2370
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN109231163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse