Provider Demographics
NPI:1881777878
Name:REED, SUSAN L (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:REED
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 STOUT DRIVE BOX 70403
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1703
Mailing Address - Country:US
Mailing Address - Phone:423-439-4515
Mailing Address - Fax:423-439-4060
Practice Address - Street 1:1136 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4824
Practice Address - Country:US
Practice Address - Phone:423-439-4515
Practice Address - Fax:423-439-5999
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3347979Medicaid
VA77-87286Medicaid
TNAPN5523OtherAPN LICENSE
3345843Medicare Oscar/Certification
TNAPN5523OtherAPN LICENSE
3345843Medicare PIN