Provider Demographics
NPI:1457675043
Name:REEDY, RICHELLE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:REEDY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:REEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2601 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4836
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2601 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4836
Practice Address - Country:US
Practice Address - Phone:405-388-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK08338654163W00000X
OK10834228163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse