{
"Npi": {
"NPI": "1902628407",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "REEDER",
"FirstName": "KYLE",
"MiddleName": "EDWARD",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DNP, APRN, FNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "REEDER",
"OtherFirstName": "KYLE",
"OtherMiddleName": "EDWARD",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DNP, FNP-BC, CNL",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1447 HARPER STREET MEDICAL OFFICE BUILDING 2ND FLOOR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AUGUSTA",
"MailingAddressStateName": "GA",
"MailingAddressPostalCode": "30912-0001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "706-721-2741",
"MailingAddressFaxNumber": "706-721-1794",
"FirstLinePracticeLocationAddress": "1447 HARPER STREET MEDICAL OFFICE BUILDING 2ND FLOOR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "AUGUSTA",
"PracticeLocationAddressStateName": "GA",
"PracticeLocationAddressPostalCode": "30912-3346",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "706-721-2741",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/28/2024",
"LastUpdateDate": "10/10/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "30597",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "RN299573",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "APRN-NP299573",
"LicenseNumberStateCode": "GA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}