Healthcare Provider Details

I. General information

NPI: 1184106809
Provider Name (Legal Business Name): KIMONE REID DNP, RN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE
STUART FL
34994-2346
US

IV. Provider business mailing address

200 SE HOSPITAL AVE
STUART FL
34994-2346
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-4993
  • Fax:
Mailing address:
  • Phone: 772-223-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11006849
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024175478
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPN.0994241-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: