Provider Demographics
NPI:1336287531
Name:REED, DEDRA RENEE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DEDRA
Middle Name:RENEE
Last Name:REED
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 FLINT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4120
Mailing Address - Country:US
Mailing Address - Phone:251-633-9154
Mailing Address - Fax:
Practice Address - Street 1:101 E I65 SERVICE RD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3900
Practice Address - Country:US
Practice Address - Phone:251-471-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-061642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily