Healthcare Provider Details

I. General information

NPI: 1477517159
Provider Name (Legal Business Name): WESLEY NEEL REID PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 12TH AVE NE
HICKORY NC
28601
US

IV. Provider business mailing address

52 12TH AVE NE
HICKORY NC
28601-2798
US

V. Phone/Fax

Practice location:
  • Phone: 828-328-2941
  • Fax: 828-328-4049
Mailing address:
  • Phone: 828-328-2941
  • Fax: 828-328-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103251
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: