Provider Demographics
NPI:1922781798
Name:REED, BARRY M SR (APRN)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:M
Last Name:REED
Suffix:SR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 KILDARE CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-7308
Mailing Address - Country:US
Mailing Address - Phone:850-830-5148
Mailing Address - Fax:
Practice Address - Street 1:11000 UNIVERSITY PKWY BLDG 85
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5732
Practice Address - Country:US
Practice Address - Phone:850-830-5148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027072363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty