Healthcare Provider Details

I. General information

NPI: 1588107031
Provider Name (Legal Business Name): HOLLY ALEXIS REED FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY LEHMAN

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4936 MAIN ST
BEMUS POINT NY
14712-9667
US

IV. Provider business mailing address

4936 MAIN ST
BEMUS POINT NY
14712-9667
US

V. Phone/Fax

Practice location:
  • Phone: 716-386-2414
  • Fax: 716-386-2437
Mailing address:
  • Phone: 716-386-2414
  • Fax: 716-386-2437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number689220
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number345077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: