Provider Demographics
NPI:1932715216
Name:REED, STACY MICHELLE (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:MICHELLE
Last Name:REED
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 HILLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-3428
Mailing Address - Country:US
Mailing Address - Phone:769-234-1513
Mailing Address - Fax:
Practice Address - Street 1:121 LONNIE JENKINS DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-3520
Practice Address - Country:US
Practice Address - Phone:769-234-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty