Provider Demographics
NPI:1356097687
Name:REID, CARLY K (FNP-S)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:K
Last Name:REID
Suffix:
Gender:F
Credentials:FNP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 D ST
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2831
Mailing Address - Country:US
Mailing Address - Phone:954-923-7440
Mailing Address - Fax:
Practice Address - Street 1:517 D ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2831
Practice Address - Country:US
Practice Address - Phone:954-923-7440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6600043-3102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily