Shea Elizabeth Reynolds

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN223462 Issued in GA

Practice address

1300 Ridenour Blvd NW Ste 300
Kennesaw, GA 30152-4402

Phone

(770) 702-1806

NPI assigned

Jan 13, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23937/brand/1/csg/1/fhir/r4

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

• Excelsis Health LLC

  • Obesity Medicine (Family Medicine) Physician
  • Marietta, GA
  • NPI 1770247736
  Medicare reassignment NPD
• Mak Anesthesia Holdings LLC

  • Anesthesiology Physician
  • Kennesaw, GA
  • NPI 1912452939
  Medicare reassignment NPD

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1235728353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 RIDENOUR BLVD NW STE 300",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 RIDENOUR BLVD NW STE 300",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524402",
            "telephone_number": "770-702-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "SHEA",
        "middle_name": "ELIZABETH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN223462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Magaly Reyes
• Jonathan Alexander Reynolds
• Joseph C Reynolds II, P.A
• Nicole Hope Reynolds
• Sandi Sierra Reynolds
• Tanya Michelle Rhoney, CCMA, SURGICAL TECH
• Sarah Rice, SLP009481
• Chad Richard
• Samantha R Richards, LCSW
• Daniel Richardson, DME

• Nurse Practitioner in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.