Basic Information
| Provider Information | |||||||||
| NPI: | 1548353477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYNOLDS | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 219975 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641219975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137894155 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11140 THOMPSON AVE | ||||||||
| Address2: | |||||||||
| City: | LENEXA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662192301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134929675 | ||||||||
| FaxNumber: | 9138949591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 05-15333 | KS | X | Allopathic & Osteopathic Physicians | Emergency Medicine | 2083X0100X | 05-15333 | KS | X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No ID Information.