MEDICARE: KIMBERLY REID

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	N26044	NY
2	164W00000X	Licensed Practical Nurse	347813	NY

General Provider Information

NPI Number	:	1316707441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY REID

Provider Business Mailing Address
First Line	:	4030 BRONX BLVD APT 5F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-3434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6424 18TH AVE FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3729
Country	:	US
Telephone Number	:	212-687-7464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	02/05/2026

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Directions to “ KIMBERLY REID ” Practice Location

Language	Start Address	Practice Location

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