Healthcare Provider Details

I. General information

NPI: 1417898040
Provider Name (Legal Business Name): KALIE REYNOLDS CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

3850 BOSTON ST APT 4089
BALTIMORE MD
21224-5773
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-9444
  • Fax:
Mailing address:
  • Phone: 772-528-2172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberR247285
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: