Healthcare Provider Details

I. General information

NPI: 1699876300
Provider Name (Legal Business Name): KIM AURORA REYNOLDS EDWARDS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/07/2023
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 EXECUTIVE CIR 102
GREENVILLE NC
27834-3749
US

IV. Provider business mailing address

PO BOX 885
AHOSKIE NC
27910-0885
US

V. Phone/Fax

Practice location:
  • Phone: 252-439-0700
  • Fax: 252-439-0900
Mailing address:
  • Phone: 252-439-0700
  • Fax: 252-439-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number200301405
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: