Provider Demographics
NPI:1164856514
Name:REYNOLDS, KAMALA G (NP)
Entity type:Individual
Prefix:
First Name:KAMALA
Middle Name:G
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-5800
Mailing Address - Country:US
Mailing Address - Phone:336-884-0387
Mailing Address - Fax:
Practice Address - Street 1:201 N PENDLETON ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-5800
Practice Address - Country:US
Practice Address - Phone:336-884-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF0713741363LF0000X
NC5006456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164856514Medicaid
NCNCP458AMedicare PIN