Healthcare Provider Details

I. General information

NPI: 1699949016
Provider Name (Legal Business Name): TAMMY DEAN REID RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3318
US

IV. Provider business mailing address

1500 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3318
US

V. Phone/Fax

Practice location:
  • Phone: 573-778-4696
  • Fax: 573-778-4699
Mailing address:
  • Phone: 573-778-4696
  • Fax: 573-778-4699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number119498
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: