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NPI Code Detail

MEDICARE: BROOKE ANNE REYNOLDS

MEDICARE:   BROOKE ANNE REYNOLDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1225813462
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE ANNE REYNOLDS
Provider Business Mailing Address
First Line : 1679 W WILSON BLVD
Second Line :
City : MOUNT JULIET
State : TN
Zip : 37122-9219
Country : US
Telephone Number : 615-689-8283
Fax Number :
Provider Business Practice Location Address
First Line : 1679 W WILSON BLVD
Second Line :
City : MOUNT JULIET
State : TN
Zip : 37122-9219
Country : US
Telephone Number : 615-689-8283
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2023
Last Update Date : 08/28/2023

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Directions to “ BROOKE ANNE REYNOLDS ” Practice Location

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