Healthcare Provider Details

I. General information

NPI: 1043192982
Provider Name (Legal Business Name): DEMETRIA NICOLE REED MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL ST STE 200
JACKSON MS
39202-1687
US

IV. Provider business mailing address

109 GLADSTONE LN
CLINTON MS
39056-5949
US

V. Phone/Fax

Practice location:
  • Phone: 601-914-9503
  • Fax:
Mailing address:
  • Phone: 601-613-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907628
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: