Healthcare Provider Details

I. General information

NPI: 1932183688
Provider Name (Legal Business Name): KORY L REED PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NORTH BROADWAY AVENUE
OKLAHOMA CITY OK
73103
US

IV. Provider business mailing address

1801 NORTH BROADWAY AVENUE
OKLAHOMA CITY OK
73103
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-2288
  • Fax: 405-755-2290
Mailing address:
  • Phone: 405-755-2288
  • Fax: 405-755-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: