Provider Demographics
NPI:1124838032
Name:REYNOLDS, LEIGH (NP)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 STONEWALL JACKSON TRL
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-0579
Mailing Address - Country:US
Mailing Address - Phone:276-336-2157
Mailing Address - Fax:
Practice Address - Street 1:675 STONEWALL JACKSON TRL
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-0579
Practice Address - Country:US
Practice Address - Phone:276-336-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF12240261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily