Provider Demographics
NPI:1225464985
Name:REED, BRADY DON (CRNA)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:DON
Last Name:REED
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 E 160TH ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:KS
Mailing Address - Zip Code:67140-9100
Mailing Address - Country:US
Mailing Address - Phone:620-892-5893
Mailing Address - Fax:
Practice Address - Street 1:658 E 160TH ST S
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:KS
Practice Address - Zip Code:67140-9100
Practice Address - Country:US
Practice Address - Phone:620-892-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS557202367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered