Provider Demographics
NPI:1982800801
Name:REED, JERRY (CRNA)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:REED
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1626
Mailing Address - Country:US
Mailing Address - Phone:334-493-3541
Mailing Address - Fax:334-493-9433
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1626
Practice Address - Country:US
Practice Address - Phone:334-493-3541
Practice Address - Fax:334-493-9433
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL35117367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51035117REEOtherBC
AL000035117Medicaid
AL51035117REEMedicare ID - Type Unspecified
ALS51655Medicare UPIN