Provider Demographics
NPI:1811004914
Name:REED-HEARN, TINA R (CPN)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:R
Last Name:REED-HEARN
Suffix:
Gender:F
Credentials:CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 BROOKMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601
Mailing Address - Country:US
Mailing Address - Phone:601-833-7973
Mailing Address - Fax:601-823-3514
Practice Address - Street 1:950 BROOKMAN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601
Practice Address - Country:US
Practice Address - Phone:601-833-7973
Practice Address - Fax:601-823-3514
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR855937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00295890OtherRAILROAD MEDICARE
MS07836065Medicaid
MSP00295890OtherRAILROAD MEDICARE
MSQ51314Medicare UPIN