Provider Demographics
NPI:1083168785
Name:REED, CARLA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:MO
Mailing Address - Zip Code:64762-0013
Mailing Address - Country:US
Mailing Address - Phone:417-843-2008
Mailing Address - Fax:417-843-2009
Practice Address - Street 1:138 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:MO
Practice Address - Zip Code:64762-9314
Practice Address - Country:US
Practice Address - Phone:417-843-2008
Practice Address - Fax:417-843-2009
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016027443363LF0000X
MO2003003569163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1215436696OtherGROUP NPI