Basic Information
| Provider Information | |||||||||
| NPI: | 1871745364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | ARDIS | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MPH RD LD CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3851 RODGER BROOKE DR. FORT SAM | ||||||||
| Address2: | MCHE-QD/CREDENTIALS BROOKE ARMY MEDICAL CENTER | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782346200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162460 | ||||||||
| FaxNumber: | 2109165102 | ||||||||
| Practice Location | |||||||||
| Address1: | 3851 RODGER BROOKE DR. FORT SAM | ||||||||
| Address2: | MCHE-QD/CREDENTIALS BROOKE ARMY MEDICAL CENTER | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782346200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109162460 | ||||||||
| FaxNumber: | 2109165102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2008 | ||||||||
| LastUpdateDate: | 10/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DT07150 | TX | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | DT07150 | 01 | TX | LICENSED DIETITIAN | OTHER | 2051-0318 | 01 | IL | CERTIFIED DIABETIC EDUCATOR-NATIONAL CERTIFICATION BOARD FOR DIABETIC EDUCATORS | OTHER | 886470 | 01 | IL | REGISTERED DIETITIAN- COMMISSION ON DIETETIC REGISTRATION | OTHER |