Provider Demographics
NPI:1942586870
Name:REYNOLDS, KAYSIEANN (FNP)
Entity type:Individual
Prefix:
First Name:KAYSIEANN
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12615 COLTART CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1603
Mailing Address - Country:US
Mailing Address - Phone:917-279-5862
Mailing Address - Fax:
Practice Address - Street 1:2445 SKYLARS MILL WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5741
Practice Address - Country:US
Practice Address - Phone:917-279-5862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645506163W00000X
GARN217653363LF0000X
NC5021446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse