Healthcare Provider Details

I. General information

NPI: 1912439175
Provider Name (Legal Business Name): KATHRYN PLIMPTON REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 WILLOW OAKS CORPORATE DR STE 400
FAIRFAX VA
22031-4513
US

IV. Provider business mailing address

8260 WILLOW OAKS CORPORATE DR STE 400
FAIRFAX VA
22031-4513
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-0504
  • Fax: 703-573-4856
Mailing address:
  • Phone: 703-573-0504
  • Fax: 703-573-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101282976
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: