Provider Demographics
NPI:1891188223
Name:REYNOLDS, ELYSIA HYMON (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:ELYSIA
Middle Name:HYMON
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 NEWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7461
Mailing Address - Country:US
Mailing Address - Phone:901-949-9464
Mailing Address - Fax:
Practice Address - Street 1:5459 N HENRY BLVD STE C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3265
Practice Address - Country:US
Practice Address - Phone:678-663-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA217693163W00000X, 363LF0000X
TN168711163W00000X
TN19932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse