Provider Demographics
NPI:1295619666
Name:REYNOLDS, KAREN PETRA
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:PETRA
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 ROANOKE
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-7686
Mailing Address - Country:US
Mailing Address - Phone:228-806-7927
Mailing Address - Fax:
Practice Address - Street 1:13801 ROANOKE
Practice Address - Street 2:
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-7686
Practice Address - Country:US
Practice Address - Phone:228-806-7927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider