Healthcare Provider Details

I. General information

NPI: 1295500189
Provider Name (Legal Business Name): ISABELLE THALA REED SOUTH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2023
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL DIV IM ENDOCRINOLOGY, STE 5C
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

4921 PARKVIEW PL STE 13B
SAINT LOUIS MO
63110-1032
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3500
  • Fax: 314-230-1119
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2023044681
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number85.010028
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: