Provider Demographics
NPI:1831366368
Name:KINSTON NEUROSCIENCE, INC
Entity type:Organization
Organization Name:KINSTON NEUROSCIENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-559-8838
Mailing Address - Street 1:1100 HARDEE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-2534
Mailing Address - Country:US
Mailing Address - Phone:252-559-8838
Mailing Address - Fax:252-559-8393
Practice Address - Street 1:1100 HARDEE RD STE 104
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-2534
Practice Address - Country:US
Practice Address - Phone:252-559-8838
Practice Address - Fax:252-559-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96017012084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910331Medicaid
NC10331OtherBCBS
NC2234514OtherCIGNA
NC2234514Medicare PIN
NCG43861Medicare UPIN