Provider Demographics
NPI:1750367934
Name:REED, RUTH LYNN (ADVANCED REGISTERED)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:LYNN
Last Name:REED
Suffix:
Gender:F
Credentials:ADVANCED REGISTERED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 S FREEBORN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:KS
Mailing Address - Zip Code:66861-1256
Mailing Address - Country:US
Mailing Address - Phone:620-382-3722
Mailing Address - Fax:620-382-3851
Practice Address - Street 1:537 S FREEBORN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KS
Practice Address - Zip Code:66861-1256
Practice Address - Country:US
Practice Address - Phone:620-382-3722
Practice Address - Fax:620-382-3851
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-03-26
Deactivation Date:2007-08-07
Deactivation Code:
Reactivation Date:2008-03-26
Provider Licenses
StateLicense IDTaxonomies
KS44316363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
R86083Medicare UPIN
160407Medicare PIN