Healthcare Provider Details

I. General information

NPI: 1336065135
Provider Name (Legal Business Name): NICOLE LOUISE REED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 ELM ST
WEIRTON WV
26062-4602
US

IV. Provider business mailing address

3050 ELM ST
WEIRTON WV
26062-4602
US

V. Phone/Fax

Practice location:
  • Phone: 740-275-6329
  • Fax:
Mailing address:
  • Phone: 740-275-6329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: