Healthcare Provider Details

I. General information

NPI: 1306850268
Provider Name (Legal Business Name): KRISTY S REYNOLDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIE SELF-REYNOLDS

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOSPITAL DR
WARRENTON VA
20186-3027
US

IV. Provider business mailing address

4094 MAJESTIC LN
FAIRFAX VA
22033-2104
US

V. Phone/Fax

Practice location:
  • Phone: 540-349-0595
  • Fax:
Mailing address:
  • Phone: 703-391-3996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number0101236678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: