Provider Demographics
NPI:1932183688
Name:REED, KORY L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KORY
Middle Name:L
Last Name:REED
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:1801 NORTH BROADWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103
Mailing Address - Country:US
Mailing Address - Phone:405-755-2288
Mailing Address - Fax:405-755-2290
Practice Address - Street 1:1801 NORTH BROADWAY AVENUE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103
Practice Address - Country:US
Practice Address - Phone:405-755-2288
Practice Address - Fax:405-755-2290
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P61689Medicare UPIN