NPI | 1417565565 |
---|---|
Former Name | KATELYN CAROLE REYNOLDS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN APN0000025308) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN0000025308) |
Enumeration Date | 2020-07-15 |
Last Update Date | 2022-01-28 |