Healthcare Provider Details

I. General information

NPI: 1104691898
Provider Name (Legal Business Name): ALLYSON PAIGE REYNOLDS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FARMINGTON AVE
BRISTOL CT
06010-4776
US

IV. Provider business mailing address

1301 FARMINGTON AVE
BRISTOL CT
06010-4776
US

V. Phone/Fax

Practice location:
  • Phone: 860-589-4501
  • Fax:
Mailing address:
  • Phone: 860-589-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12639
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: