MEDICARE: MR. MARK THOMAS REED MSN FNP-BC

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	363LF0000X	Family Nurse Practitioner	20341	CA
2	363LF0000X	Family Nurse Practitioner	201809623NP-PP	OR

General Provider Information

NPI Number	:	1558674796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK THOMAS REED MSN FNP-BC

Provider Business Mailing Address
First Line	:	2865 DAGGETT AVE
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1106
Country	:	US
Telephone Number	:	541-274-6175
Fax Number	:	541-274-6739

Provider Business Practice Location Address
First Line	:	2821 DAGGETT AVE STE 200
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1130
Country	:	US
Telephone Number	:	541-271-8400
Fax Number	:	541-274-8405

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

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	07/27/2022

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