Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 50461 | KY |
N | 208600000X | Surgeon | 50461 | KY |
N | 2086S0102X | Surgical Critical Care | 50461 | KY |
Y | 2086S0127X | Trauma Surgeon | 50461 | KY |
NPI | 1316237969 |
---|---|
Provider Name | Jessica Kathleen Reynolds |
First Address | Lexington, KY 40536-0293 |
Second Address | Lexington, KY 40536-2147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2011 |
Last Update Date | 14/07/2017 |