Healthcare Provider Details

I. General information

NPI: 1215001573
Provider Name (Legal Business Name): PHYLLIS B. REED ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 HELTON ST ABUNDANT LIVING COUNSELING
WILLIAMSTOWN KY
41097-3526
US

IV. Provider business mailing address

265 FERNWOOD DR
WILLIAMSTOWN KY
41097-4203
US

V. Phone/Fax

Practice location:
  • Phone: 859-391-6046
  • Fax: 859-824-7091
Mailing address:
  • Phone: 859-391-6046
  • Fax: 859-824-7091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3005009
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1026616
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: