MEDICARE: STEPHEN LARRY REID FNP

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	642078	TX

General Provider Information

NPI Number	:	1750513131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN LARRY REID FNP

Provider Business Mailing Address
First Line	:	2800 HICKORY
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-4782
Country	:	US
Telephone Number	:	409-722-6789
Fax Number	:

Provider Business Practice Location Address
First Line	:	3128 SABA LN
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5422
Country	:	US
Telephone Number	:	409-724-1404
Fax Number	:

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

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	07/17/2013

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