Provider Demographics
NPI:1184320806
Name:REYNOLDS, BARBARA VICTORIA (RN REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:VICTORIA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8812
Mailing Address - Country:US
Mailing Address - Phone:910-845-2311
Mailing Address - Fax:
Practice Address - Street 1:739 S SHORE DR
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8812
Practice Address - Country:US
Practice Address - Phone:910-845-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC270220163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health