Provider Demographics
NPI:1942837521
Name:REID, STEPHANIE Y (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:Y
Last Name:REID
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 PEPPERTREE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-9785
Mailing Address - Country:US
Mailing Address - Phone:252-526-1810
Mailing Address - Fax:
Practice Address - Street 1:2818 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2850
Practice Address - Country:US
Practice Address - Phone:252-636-4920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC225764363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner