Healthcare Provider Details

I. General information

NPI: 1518952878
Provider Name (Legal Business Name): AMANDA L REID PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E COLLEGE DR
COLBY KS
67701-3716
US

IV. Provider business mailing address

310 E COLLEGE DR
COLBY KS
67701-3716
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-6184
  • Fax: 785-460-1490
Mailing address:
  • Phone: 785-460-6184
  • Fax: 785-460-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberT00131
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: