Healthcare Provider Details

I. General information

NPI: 1912140971
Provider Name (Legal Business Name): KRISTINA S REED RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MADISON AVE
MEMPHIS TN
38103-3409
US

IV. Provider business mailing address

4020 THYATIRA TYRO RD
SENATOBIA MS
38668-5640
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-6969
  • Fax:
Mailing address:
  • Phone: 662-863-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39540
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number884844
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907689
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: