MEDICARE: KRISTY LYNN REYNOLDS FNP-BC

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	71007999A	IN

General Provider Information

NPI Number	:	1750884607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY LYNN REYNOLDS FNP-BC

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	489 S STATE ROAD 135 STE F
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-1407
Country	:	US
Telephone Number	:	317-887-7640
Fax Number	:

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

Provider Enumeration Date	:	03/16/2018
Last Update Date	:	01/06/2026

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