Provider Demographics
NPI:1457868507
Name:REYNOLDS, KRISTEN T (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:T
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 1:795 WINDWILLOW CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4153
Mailing Address - Country:US
Mailing Address - Phone:321-263-5730
Mailing Address - Fax:
Practice Address - Street 1:795 WINDWILLOW CIR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4153
Practice Address - Country:US
Practice Address - Phone:321-263-5730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9349503163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant