Provider Demographics
NPI:1790215937
Name:REYNOLDS, KAREN ANN (RDN/LD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 ARBORVIEW LN
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-5312
Mailing Address - Country:US
Mailing Address - Phone:917-817-8163
Mailing Address - Fax:
Practice Address - Street 1:477 ARBORVIEW LN
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-5312
Practice Address - Country:US
Practice Address - Phone:917-817-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND7941133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered