Provider Demographics
NPI:1972708923
Name:REYNOLDS, KASIE DELAINE (RN, MS,CPNP (APN))
Entity type:Individual
Prefix:MRS
First Name:KASIE
Middle Name:DELAINE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:RN, MS,CPNP (APN)
Other - Prefix:
Other - First Name:KASIE
Other - Middle Name:D
Other - Last Name:ELAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1155 MILL ST MS M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:75 PRINGLE WAY STE 300
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-8425
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3900
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX625958363LP0200X
NVAPRN000948363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
11934112OtherCAQH
NV1972708923Medicaid
NV1972708923Medicaid
NVCG122YMedicare PIN