Healthcare Provider Details

I. General information

NPI: 1891072575
Provider Name (Legal Business Name): KATHLEEN MARY REID RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 E VERMONT AVE
FRESNO CA
93720-5327
US

IV. Provider business mailing address

PO BOX 1616
CLOVIS CA
93613-1616
US

V. Phone/Fax

Practice location:
  • Phone: 559-970-0677
  • Fax:
Mailing address:
  • Phone: 559-970-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number439156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: