Healthcare Provider Details

I. General information

NPI: 1992223895
Provider Name (Legal Business Name): CASSANDRA K REED FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 W STEPHENSON ST
FREEPORT IL
61032-4865
US

IV. Provider business mailing address

421 W EXCHANGE ST
FREEPORT IL
61032-4008
US

V. Phone/Fax

Practice location:
  • Phone: 815-599-7770
  • Fax: 815-599-7613
Mailing address:
  • Phone: 815-599-7925
  • Fax: 815-599-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016378
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number209-016378
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number209-016378
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: