Healthcare Provider Details

I. General information

NPI: 1326052457
Provider Name (Legal Business Name): KELLY REED NP,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/27/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 RALSTON ST
VENTURA CA
93003-6002
US

IV. Provider business mailing address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

V. Phone/Fax

Practice location:
  • Phone: 805-658-3232
  • Fax:
Mailing address:
  • Phone: 607-366-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number415733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: