Healthcare Provider Details

I. General information

NPI: 1336848381
Provider Name (Legal Business Name): BETHANY E REYNOLDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY E NELMS

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN STE 210
DANVILLE IN
46122-1845
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-9040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28207345A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013671A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number71013671A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: