Healthcare Provider Details

I. General information

NPI: 1366656159
Provider Name (Legal Business Name): KATHLEEN WALSH REYNOLDS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 BRAVENDER WAY
DUXBURY MA
02332-4140
US

IV. Provider business mailing address

67 BRAVENDER WAY
DUXBURY MA
02332-4140
US

V. Phone/Fax

Practice location:
  • Phone: 781-583-3689
  • Fax: 781-854-5773
Mailing address:
  • Phone: 781-583-3689
  • Fax: 781-854-5773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN2290203
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: