Provider Demographics
NPI:1619953635
Name:REID, KATHLEEN A (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:REID
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:354 BIRNIE AVE
Mailing Address - Street 2:HAMPDEN COUNTY PHYSICIAN ASSOC LLC
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1108
Mailing Address - Country:US
Mailing Address - Phone:413-733-3470
Mailing Address - Fax:413-733-5235
Practice Address - Street 1:98 SHAKER ROAD
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:413-525-1554
Practice Address - Fax:413-525-7764
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2008-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA165153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2505Medicare PIN
500017196Medicare PIN
P09469Medicare UPIN