Provider Demographics
NPI:1336764778
Name:REED-WASHINGTON, RAQUEL JANAY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:JANAY
Last Name:REED-WASHINGTON
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:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-0754
Mailing Address - Country:US
Mailing Address - Phone:662-910-9423
Mailing Address - Fax:
Practice Address - Street 1:3548 HERBERT CV
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-2003
Practice Address - Country:US
Practice Address - Phone:662-910-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27403363LF0000X
MS904716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily