Healthcare Provider Details

I. General information

NPI: 1689397564
Provider Name (Legal Business Name): KELLY JANE REYNOLDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CLAYTON AVE
CORTLAND NY
13045-2501
US

IV. Provider business mailing address

7 CLAYTON AVE
CORTLAND NY
13045-2501
US

V. Phone/Fax

Practice location:
  • Phone: 607-758-6100
  • Fax: 607-758-6116
Mailing address:
  • Phone: 607-758-6100
  • Fax: 607-758-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number732922
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: