Basic Information
| Provider Information | |||||||||
| NPI: | 1982800801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REED | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OPP | ||||||||
| State: | AL | ||||||||
| PostalCode: | 364671626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3344933541 | ||||||||
| FaxNumber: | 3344939433 | ||||||||
| Practice Location | |||||||||
| Address1: | 702 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | OPP | ||||||||
| State: | AL | ||||||||
| PostalCode: | 364671626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3344933541 | ||||||||
| FaxNumber: | 3344939433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 10/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AL35117 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 51035117REE | 01 | AL | BC | OTHER | 000035117 | 05 | AL | MEDICAID |