Individual
LISA REYNOLDS EDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
201 PARK ST, BOWLING GREEN, KY 42101-1759
(270) 781-5111
Mailing address
201 PARK ST, BOWLING GREEN, KY 42101-1759
(270) 781-5111
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
39663
KY
207V00000X
Obstetrics & Gynecology Physician
Primary
39663
KY
208M00000X
Hospitalist Physician
39663
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000642826
ANTHEM BCBS PROVIDER #
KY
05
—
64114119
—
KY
05
—
7100102130
—
KY
01
—
7655700
AETNA PROVIDER #
KY
Enumeration date
03/20/2008
Last updated
08/24/2021
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