Healthcare Provider Details

I. General information

NPI: 1295868974
Provider Name (Legal Business Name): LISA E REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BLYTHEWOOD DR
COLUMBIA TN
38401-4828
US

IV. Provider business mailing address

100 BLYTHEWOOD DR
COLUMBIA TN
38401-4828
US

V. Phone/Fax

Practice location:
  • Phone: 931-381-5757
  • Fax:
Mailing address:
  • Phone: 931-381-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: