Individual
BETHANY E REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2705 N LEBANON ST STE 342, LEBANON, IN 46052-8621
(765) 485-8740
(765) 485-8749
Mailing address
2605 N LEBANON ST, LEBANON, IN 46052-1476
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28207345A
IN
207RC0000X
Cardiovascular Disease Physician
Primary
71013671A
IN
363LF0000X
Family Nurse Practitioner
71013671A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300073000
—
IN
Enumeration date
02/28/2023
Last updated
10/20/2023
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