Provider Demographics
NPI:1770192700
Name:REID, JENNIFER TAYLOR (DNP, AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TAYLOR
Last Name:REID
Suffix:
Gender:F
Credentials:DNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:481 LOBLOLLY DR
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-8216
Mailing Address - Country:US
Mailing Address - Phone:910-690-7323
Mailing Address - Fax:
Practice Address - Street 1:1991 FORDHAM DR STE 302
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3774
Practice Address - Country:US
Practice Address - Phone:910-491-6793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013350363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner