Basic Information
| Provider Information | |||||||||
| NPI: | 1881719938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | T. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1407 UNION AVE STE 700 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381043641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018668622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 PRIMACY PKWY | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014480276 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | APN0000006103 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | APN0000006103 | 01 | TN | NURSE PRACTIONER LICENSE | OTHER | Q033059 | 05 | TN | MEDICAID | R868376 | 01 | MS | REGISTERED NURSE LICENSE | OTHER | MR0637439 | 01 | TN | DEA NUMBER | OTHER | 00122841 | 05 | MS | MEDICAID | 1881719938 | 05 | MO | MEDICAID |