Provider Demographics
NPI:1962463521
Name:REED, GLORIA (NP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1319
Mailing Address - Country:US
Mailing Address - Phone:803-245-2433
Mailing Address - Fax:803-245-6274
Practice Address - Street 1:526 NORTH ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1319
Practice Address - Country:US
Practice Address - Phone:803-245-2433
Practice Address - Fax:803-245-6274
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN884363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1825Medicaid
SCSCE372OtherMEDICARE
SC0884OtherMEDICAL LICENSE
SCRHC020Medicaid
SCRHC151Medicaid
SC4173Medicare PIN