Provider Demographics
NPI:1245215086
Name:REID, YOLANDA Y (NP)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:Y
Last Name:REID
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 PEMBROKE CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-7421
Mailing Address - Country:US
Mailing Address - Phone:270-843-4531
Mailing Address - Fax:270-783-4081
Practice Address - Street 1:1109 STATE ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2648
Practice Address - Country:US
Practice Address - Phone:270-781-2490
Practice Address - Fax:270-781-2520
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4671P363LF0000X
KY3004671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78015856Medicaid
KYK158477Medicare PIN
KYK158473Medicare PIN
KYK158479Medicare PIN
KY78015856Medicaid
KYK158472Medicare PIN
KYK158478Medicare PIN
KYK158476Medicare PIN
0679712Medicare PIN
KYK158474Medicare PIN