Provider Demographics
NPI:1932713831
Name:REYNOLDS, STEPHEN JAMES LAYNE
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JAMES LAYNE
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 THOMPSON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2080
Mailing Address - Country:US
Mailing Address - Phone:304-542-4138
Mailing Address - Fax:
Practice Address - Street 1:4825 BROWNS CREEK RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-8740
Practice Address - Country:US
Practice Address - Phone:304-356-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant