Healthcare Provider Details

I. General information

NPI: 1609793181
Provider Name (Legal Business Name): AMANDA REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W FRONT ST
LILLINGTON NC
27546-7940
US

IV. Provider business mailing address

700 W FRONT ST
LILLINGTON NC
27546-7940
US

V. Phone/Fax

Practice location:
  • Phone: 919-480-1421
  • Fax:
Mailing address:
  • Phone: 919-480-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: