Healthcare Provider Details

I. General information

NPI: 1033619077
Provider Name (Legal Business Name): JANA ETHEL REID PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 PORTER WAGONER BLVD
WEST PLAINS MO
65775-1826
US

IV. Provider business mailing address

1211 PORTER WAGONER BLVD # 23
WEST PLAINS MO
65775-1826
US

V. Phone/Fax

Practice location:
  • Phone: 417-349-2334
  • Fax:
Mailing address:
  • Phone: 417-257-6762
  • Fax: 417-257-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2005007398
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-81126-011
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: