Healthcare Provider Details

I. General information

NPI: 1174460190
Provider Name (Legal Business Name): PAYTON REYNOLDS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 S KANSAS AVE STE 2
TOPEKA KS
66612-1249
US

IV. Provider business mailing address

18600 E 37TH TER S
INDEPENDENCE MO
64057-1707
US

V. Phone/Fax

Practice location:
  • Phone: 785-330-5562
  • Fax:
Mailing address:
  • Phone: 816-350-0215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: