Provider Demographics
NPI:1295500189
Name:SOUTH, ISABELLE THALA REED (PA)
Entity type:Individual
Prefix:MS
First Name:ISABELLE
Middle Name:THALA REED
Last Name:SOUTH
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Gender:F
Credentials:PA
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Mailing Address - Street 1:4921 PARKVIEW PL STE 13B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV IM ENDOCRINOLOGY, STE 5C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-3500
Practice Address - Fax:314-230-1119
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2025-08-20
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Provider Licenses
StateLicense IDTaxonomies
MO2023044681363A00000X
IL85.010028363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220136215Medicaid