MEDICARE: KAREN RICHARDS-REYNOLDS FNP-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	363LF0000X	Family Nurse Practitioner	RN154504	GA

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	:	1699927681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN RICHARDS-REYNOLDS FNP-C

Provider Business Mailing Address
First Line	:	1058 BEAR CREEK BLVD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-1849
Country	:	US
Telephone Number	:	770-707-0808
Fax Number	:	770-707-1580

Provider Business Practice Location Address
First Line	:	1058 BEAR CREEK BLVD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-1849
Country	:	US
Telephone Number	:	770-707-0808
Fax Number	:	770-707-1580

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	06/09/2010

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