Provider Demographics
NPI:1033619077
Name:REID, JANA ETHEL (PMHNP)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:ETHEL
Last Name:REID
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 PORTER WAGONER BLVD # 23
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1826
Mailing Address - Country:US
Mailing Address - Phone:417-257-6762
Mailing Address - Fax:417-257-5875
Practice Address - Street 1:1211 PORTER WAGONER BLVD
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-1826
Practice Address - Country:US
Practice Address - Phone:417-349-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005007398363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner