Healthcare Provider Details

I. General information

NPI: 1548353477
Provider Name (Legal Business Name): KENNETH R REYNOLDS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 THOMPSON AVE
LENEXA KS
66219-2301
US

IV. Provider business mailing address

PO BOX 219975
KANSAS CITY MO
64121-9975
US

V. Phone/Fax

Practice location:
  • Phone: 913-492-9675
  • Fax: 913-894-9591
Mailing address:
  • Phone: 913-789-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number05-15333
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number05-15333
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: