Healthcare Provider Details

I. General information

NPI: 1063326494
Provider Name (Legal Business Name): KAYLA REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 BONNER RD
GAFFNEY SC
29341-4705
US

IV. Provider business mailing address

577 BONNER RD
GAFFNEY SC
29341-4705
US

V. Phone/Fax

Practice location:
  • Phone: 864-809-2077
  • Fax:
Mailing address:
  • Phone: 864-809-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4059921
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: