Provider Demographics
NPI:1144645904
Name:REYNOLDS, KRYSTIN RAE (LPN)
Entity type:Individual
Prefix:MS
First Name:KRYSTIN
Middle Name:RAE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5589 CAMP RD
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-9031
Mailing Address - Country:US
Mailing Address - Phone:330-234-4115
Mailing Address - Fax:
Practice Address - Street 1:5589 CAMP RD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287-9031
Practice Address - Country:US
Practice Address - Phone:330-234-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136135164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse