Provider Demographics
NPI:1861537011
Name:REYNOLDS, KRISTEN KEELING (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:KEELING
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E JEFFERSON ST
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1246
Mailing Address - Country:US
Mailing Address - Phone:502-569-1584
Mailing Address - Fax:502-569-1586
Practice Address - Street 1:201 E JEFFERSON ST
Practice Address - Street 2:SUITE 309
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1246
Practice Address - Country:US
Practice Address - Phone:502-569-1584
Practice Address - Fax:502-569-1586
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200251246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000531561OtherANTHEM
KY4017401Medicare PIN