Healthcare Provider Details

I. General information

NPI: 1902628407
Provider Name (Legal Business Name): KYLE EDWARD REEDER DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KYLE EDWARD REEDER DNP, FNP-BC, CNL

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 HARPER STREET MEDICAL OFFICE BUILDING 2ND FLOOR
AUGUSTA GA
30912-3346
US

IV. Provider business mailing address

1447 HARPER STREET MEDICAL OFFICE BUILDING 2ND FLOOR
AUGUSTA GA
30912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2741
  • Fax:
Mailing address:
  • Phone: 706-721-2741
  • Fax: 706-721-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30597
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN299573
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP299573
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: