Provider Demographics
NPI:1407992795
Name:REID, KELLY DAWN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:DAWN
Last Name:REID
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-1867
Mailing Address - Country:US
Mailing Address - Phone:636-677-6744
Mailing Address - Fax:
Practice Address - Street 1:1708 SPRUCE DR
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-1867
Practice Address - Country:US
Practice Address - Phone:636-677-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO130624163WA2000X, 163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Not Answered163WC1400XNursing Service ProvidersRegistered NurseCollege Health