Provider Demographics
NPI:1679599807
Name:MCDOWELL, REIDA GENTRY (FNP)
Entity Type:Individual
Prefix:MS
First Name:REIDA
Middle Name:GENTRY
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8056
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-4564
Mailing Address - Fax:314-362-7086
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-4564
Practice Address - Fax:314-362-7086
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2003026036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO818150183Medicaid
MO818150183Medicaid
MO818150183Medicare PIN