Provider Demographics
NPI:1811577240
Name:REED, KELLEENA MAUREEN (APRN)
Entity Type:Individual
Prefix:
First Name:KELLEENA
Middle Name:MAUREEN
Last Name:REED
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 SHERWOOD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-1942
Mailing Address - Country:US
Mailing Address - Phone:904-235-3512
Mailing Address - Fax:
Practice Address - Street 1:1280 HENLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-7886
Practice Address - Country:US
Practice Address - Phone:904-349-9176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily