Healthcare Provider Details

I. General information

NPI: 1649341256
Provider Name (Legal Business Name): ANN REED NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN JOHNSON NP

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LEISURE TIME DR
DIAMONDHEAD MS
39525-3241
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502-1810
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-4300
  • Fax: 228-255-3626
Mailing address:
  • Phone: 228-586-0750
  • Fax: 228-255-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR634425
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: