Provider Demographics
NPI:1821193525
Name:REED, JOSEPH R (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:REED
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 75TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2525
Mailing Address - Country:US
Mailing Address - Phone:806-712-1096
Mailing Address - Fax:806-771-2093
Practice Address - Street 1:1 TRILLIUM WAY LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8426
Practice Address - Country:US
Practice Address - Phone:270-575-2100
Practice Address - Fax:270-415-7229
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000899363A00000X
KYPA660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522565Medicaid
KY95002598Medicaid
KY0329114Medicare ID - Type Unspecified
TN3671984Medicare ID - Type Unspecified
KY95002598Medicaid