=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962355370
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIERA REYNOLDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2026
-----------------------------------------------------
Last Update Date | 02/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4067 PLATTE AVE
-----------------------------------------------------
City | GROVEPORT
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43125-9470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-928-5611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4067 PLATTE AVE
-----------------------------------------------------
City | GROVEPORT
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43125-9470
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-928-5611
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | TT577876
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------