Healthcare Provider Details

I. General information

NPI: 1982103016
Provider Name (Legal Business Name): KAREN DEE REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 GATEWAY LOOP STE 200
SPRINGFIELD OR
97477-7706
US

IV. Provider business mailing address

1144 GATEWAY LOOP STE 200
SPRINGFIELD OR
97477-7706
US

V. Phone/Fax

Practice location:
  • Phone: 541-600-8679
  • Fax:
Mailing address:
  • Phone: 541-686-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number112067
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: