Provider Demographics
NPI:1548570443
Name:REEDER, JACKIE DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JACKIE
Middle Name:DAVID
Last Name:REEDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1808 SHERMAN DRIVE
Mailing Address - Street 2:GIBSON GENERAL HOSPITAL
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670
Mailing Address - Country:US
Mailing Address - Phone:812-385-9208
Mailing Address - Fax:812-385-9410
Practice Address - Street 1:1808 SHERMAN DRIVE
Practice Address - Street 2:GIBSON GENERAL HOSPITAL
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670
Practice Address - Country:US
Practice Address - Phone:812-385-9208
Practice Address - Fax:812-385-9410
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000268A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant