1699763441 NPI number — REDA DENISE REED APN

Table of content: REDA DENISE REED APN (NPI 1699763441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699763441 NPI number — REDA DENISE REED APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED
Provider First Name:
REDA
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699763441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9662
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72033-9662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-852-1363
Provider Business Mailing Address Fax Number:
501-852-1364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 ALTUS ST
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72032-4299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-450-1448
Provider Business Practice Location Address Fax Number:
501-450-1324
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  A01565 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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