Healthcare Provider Details

I. General information

NPI: 1124076278
Provider Name (Legal Business Name): KATHY L REYNOLDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST 21ST STREET
SIOUX FALLS SD
57105-1016
US

IV. Provider business mailing address

PO BOX 1450 NW 0090
MINNEAPOLIS MN
55485-0090
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-8000
  • Fax:
Mailing address:
  • Phone: 800-279-1395
  • Fax: 517-694-6441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number4743
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9701856
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number11712
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number4743
License Number StateSD
# 5
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number38372
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier891113P
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier002019725
Identifier TypeMEDICAID
Identifier StateNV
Identifier Issuer
# 3
Identifier64900789
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 4
Identifier063407700
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 5
Identifier6700510
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: