Provider Demographics
NPI:1023704483
Name:REED, WILLIAM PATRICK
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:REED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:150 W BEAR TRACK RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8709
Mailing Address - Country:US
Mailing Address - Phone:270-465-8133
Mailing Address - Fax:270-789-1543
Practice Address - Street 1:150 W BEAR TRACK RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-8709
Practice Address - Country:US
Practice Address - Phone:270-465-8133
Practice Address - Fax:270-789-1543
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2704363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical