Individual provider Active NPI

Tyler Lynne Reynolds, PA-C

  • Physician Assistant
  • Cartersville, GA
National Provider Identifier
1164373106
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13713 Issued in GA
Practice address
150 Gentilly Blvd
Cartersville, GA 30120-8522
Phone
(470) 490-6445
NPI assigned
Feb 5, 2026
Last updated
Aug 10, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13713 GA Primary

Addresses

Primary practice location

150 Gentilly Blvd
Cartersville, GA 30120-8522

Mailing address

150 Gentilly Blvd
Cartersville, GA 30120-8522
Phone (470) 490-6445

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260420003724 GA Practitioner - Physician Assistant 2062988603 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Harbin Clinic LLCGroup PAC ID 0446154231, 238 clinicians

Practice addresses (Care Compare)

150 Gentilly Blvd
Cartersville, GA 30120-8522
Phone (470) 490-7470

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13713GAMDPsychiatry Physician

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1770249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786320000000",
    "number": "1164373106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 GENTILLY BLVD",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301208522",
            "telephone_number": "470-490-6445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 GENTILLY BLVD",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301208522",
            "telephone_number": "470-490-6445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "TYLER",
        "middle_name": "LYNNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-05",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "13713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cartersville, GA

Sources for this page

Verify at the official NPI Registry.