Healthcare Provider Details

I. General information

NPI: 1932018546
Provider Name (Legal Business Name): KAYLEE REYES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E BROAD ST
RICHMOND VA
23219-1930
US

IV. Provider business mailing address

4019 OLD CREEK RD
CHESTERFIELD VA
23832-8387
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-2467
  • Fax:
Mailing address:
  • Phone: 252-458-7883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: