Provider Demographics
NPI:1174294193
Name:REEDER, KENZIE RAYE
Entity Type:Individual
Prefix:MRS
First Name:KENZIE
Middle Name:RAYE
Last Name:REEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KENZIE
Other - Middle Name:RAYE
Other - Last Name:MCGOWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KENZIE RAYE MCGOWAN
Mailing Address - Street 1:1009A N DUPONT SQ
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4612
Mailing Address - Country:US
Mailing Address - Phone:502-894-9950
Mailing Address - Fax:
Practice Address - Street 1:1009A N DUPONT SQ
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4612
Practice Address - Country:US
Practice Address - Phone:502-894-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-21
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016700363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care