Healthcare Provider Details

I. General information

NPI: 1215163563
Provider Name (Legal Business Name): ANNETTE REYNOLDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 DOLWICK DRIVE
ERLANGER KY
41018-2774
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-5901
  • Fax: 859-301-5940
Mailing address:
  • Phone: 859-301-5901
  • Fax: 859-301-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number46291
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number46291
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.122899
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: