MEDICARE: CAMERON LEWIS REYNOLDS NURSE PRACTITIONER

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024183628	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306509633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON LEWIS REYNOLDS NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	4600 MONTGOMERY RD STE 400
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2600
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:	866-460-2997

Provider Business Practice Location Address
First Line	:	5001 W VILLAGE GREEN DR STE 205
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-4801
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:	866-460-2997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	01/19/2026

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Directions to “ CAMERON LEWIS REYNOLDS NURSE PRACTITIONER” Practice Location

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