Provider Demographics
NPI:1699876300
Name:REYNOLDS EDWARDS, KIM AURORA (MD)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:AURORA
Last Name:REYNOLDS EDWARDS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 885
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0885
Mailing Address - Country:US
Mailing Address - Phone:252-439-0700
Mailing Address - Fax:252-439-0900
Practice Address - Street 1:2305 EXECUTIVE CIR
Practice Address - Street 2:102
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3749
Practice Address - Country:US
Practice Address - Phone:252-439-0700
Practice Address - Fax:252-439-0900
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2003014052084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891350Medicaid
NC200301405OtherSTATE LICENSE
NCBR8625898OtherDEA NUMBER
NCBR8625898OtherDEA NUMBER