Doctor Name: | KIMRA REED |
NPI Number: | 1457744849 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 28123520A |
Business Practice Address: | 508 E Ellsworth St Columbia City, IN - 467252504 |
Business Phone Number: | 2606103057 |
Business Fax Number: | |
Mailing Address: | 508 E Ellsworth St, COLUMBIA CITY |
State: | IN |
Postal Code: | 467252504 |
Phone Number: | 2606103057 |
Fax Number: | |
NPI Enumeration Date: | 03/10/2015 |
NPI Last Update Date: | 03/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | 28123520A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |