Provider Demographics
NPI:1629574512
Name:REIDHEAD, AMY CAROL (DC, FNP-C, BSN-RN)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:CAROL
Last Name:REIDHEAD
Suffix:
Gender:F
Credentials:DC, FNP-C, BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 CANYON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5652
Mailing Address - Country:US
Mailing Address - Phone:303-390-1245
Mailing Address - Fax:303-390-1245
Practice Address - Street 1:2355 CANYON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5652
Practice Address - Country:US
Practice Address - Phone:303-390-1245
Practice Address - Fax:303-390-1245
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4468111N00000X
CO0202308163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No163W00000XNursing Service ProvidersRegistered Nurse