Provider Demographics
NPI:1821729740
Name:REYNOLDS, KYLE ROBERT (CNA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ROBERT
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N 64TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-3808
Mailing Address - Country:US
Mailing Address - Phone:618-397-8400
Mailing Address - Fax:
Practice Address - Street 1:40 N 64TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-3808
Practice Address - Country:US
Practice Address - Phone:618-397-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide