Provider Demographics
NPI:1649341256
Name:REED, ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-586-0750
Mailing Address - Fax:228-255-5250
Practice Address - Street 1:4300 LEISURE TIME DR
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3241
Practice Address - Country:US
Practice Address - Phone:228-255-4300
Practice Address - Fax:228-255-3626
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR634425363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner