Healthcare Provider Details

I. General information

NPI: 1386359057
Provider Name (Legal Business Name): RHONDA LASHAY REED CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARK PL
SELMA AL
36701-6764
US

IV. Provider business mailing address

174 COUNTY ROAD 269
VALLEY GRANDE AL
36701-9310
US

V. Phone/Fax

Practice location:
  • Phone: 334-877-1490
  • Fax:
Mailing address:
  • Phone: 334-419-5896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-141943
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10220718
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: