Provider Demographics
NPI:1881603785
Name:REED, LINDA (PA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CAMP BOWIE BLVD
Mailing Address - Street 2:EAD 324
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2644
Mailing Address - Country:US
Mailing Address - Phone:817-735-0170
Mailing Address - Fax:817-735-0111
Practice Address - Street 1:3500 CAMP BOWIE BLVD
Practice Address - Street 2:ENX1 109
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2644
Practice Address - Country:US
Practice Address - Phone:817-735-0310
Practice Address - Fax:817-735-2529
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX576626Medicare UPIN
TX82N564Medicare ID - Type Unspecified