Provider Demographics
NPI:1386612422
Name:REYNOLDS, BETSY TUCKER (MD)
Entity type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:TUCKER
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:298 BOGLE ST
Practice Address - Street 2:STE B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-679-9213
Practice Address - Fax:606-677-9963
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64205180Medicaid
1167822OtherCHA HEALTH
000000052015OtherBLUE CROSS BLUE SHIELD
C70971Medicare UPIN
KY5715Medicare ID - Type Unspecified