Provider Demographics
NPI:1447212360
Name:REED, VICKI L (PA-C)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:REED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 S ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5150
Mailing Address - Country:US
Mailing Address - Phone:316-682-7411
Mailing Address - Fax:
Practice Address - Street 1:1709 S ROCK RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5150
Practice Address - Country:US
Practice Address - Phone:316-682-7411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00462363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042752OtherBCBS PROVIDER NUMBER
KS042752OtherBCBS PROVIDER NUMBER
KS042752OtherBCBS PROVIDER NUMBER