Provider Demographics
NPI:1376987073
Name:REID, KIM ELIZABETH (AP)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ELIZABETH
Last Name:REID
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LOCH VAIL UNIT 21
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-2669
Mailing Address - Country:US
Mailing Address - Phone:817-681-3924
Mailing Address - Fax:
Practice Address - Street 1:1003 DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-3021
Practice Address - Country:US
Practice Address - Phone:813-304-3834
Practice Address - Fax:813-501-8700
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist