MEDICARE: KIMBERLEY REYNOLDS M.ED., L.P.C.

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	101Y00000X	Counselor	2006	NC

General Provider Information

NPI Number	:	1558300277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY REYNOLDS M.ED., L.P.C.

Provider Business Mailing Address
First Line	:	4401 COLWICK RD
Second Line	:	#705
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2349
Country	:	US
Telephone Number	:	704-366-1923
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 COLWICK RD
Second Line	:	#705
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2349
Country	:	US
Telephone Number	:	704-366-1923
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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