Provider Demographics
NPI:1215001573
Name:REED, PHYLLIS B (ARNP)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:B
Last Name:REED
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:41097-4203
Mailing Address - Country:US
Mailing Address - Phone:859-391-6046
Mailing Address - Fax:859-824-7091
Practice Address - Street 1:486 HELTON ST
Practice Address - Street 2:ABUNDANT LIVING COUNSELING
Practice Address - City:WILLIAMSTOWN
Practice Address - State:KY
Practice Address - Zip Code:41097-3526
Practice Address - Country:US
Practice Address - Phone:859-391-6046
Practice Address - Fax:859-824-7091
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1026616163W00000X
KY3005009363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78018033Medicaid
KYP00677533OtherRAIL ROAD MEDICARE
KY0969420Medicare PIN