Provider Demographics
NPI:1942586870
Name:REYNOLDS, KAYSIEANN (RN)
Entity Type:Individual
Prefix:
First Name:KAYSIEANN
Middle Name:
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 1937
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-1937
Mailing Address - Country:US
Mailing Address - Phone:917-279-5862
Mailing Address - Fax:
Practice Address - Street 1:240 PROSPECT AVE
Practice Address - Street 2:APT 284
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2511
Practice Address - Country:US
Practice Address - Phone:917-279-5862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645506163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse