Healthcare Provider Details

I. General information

NPI: 1477357820
Provider Name (Legal Business Name): DALYN REYNOLDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CENTRAL AVE
LAUREL MS
39440
US

IV. Provider business mailing address

150 RASTUS RIELS RD
SEMINARY MS
39479-8939
US

V. Phone/Fax

Practice location:
  • Phone: 601-580-2513
  • Fax:
Mailing address:
  • Phone: 601-580-2513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number907196
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: