Provider Demographics
NPI:1629600432
Name:REID, JENNY MARIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:REID
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:KIRKLAND
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3120 N OAK STREET EXT STE C
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5910
Mailing Address - Country:US
Mailing Address - Phone:229-671-3500
Mailing Address - Fax:
Practice Address - Street 1:3116 N OAK STREET EXT
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1007
Practice Address - Country:US
Practice Address - Phone:229-671-3500
Practice Address - Fax:229-671-3532
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128376363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health