Individual
KYLE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3009 NEW BERN AVE, RALEIGH, NC 27610-1214
(919) 232-5020
Mailing address
3009 NEW BERN AVE, RALEIGH, NC 27610-1214
(805) 368-1205
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-10494
NC
363AS0400X
Surgical Physician Assistant
Primary
0010-10494
NC
Other
Enumeration date
03/27/2020
Last updated
11/02/2020
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