Provider Demographics
NPI:1114157500
Name:REED, JENNIFER R (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:REED
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12222 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3755
Mailing Address - Country:US
Mailing Address - Phone:214-615-1944
Mailing Address - Fax:214-615-1949
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:SUITE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3755
Practice Address - Country:US
Practice Address - Phone:214-615-1944
Practice Address - Fax:214-615-1949
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06269363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA06269OtherSTATE LICENCE NUMBER