=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134991326
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAMELA BARBER REID, APRN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2023
-----------------------------------------------------
Last Update Date | 10/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1616 S COLUMBIA ST STE C
-----------------------------------------------------
City | BOGALUSA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70427-5881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-335-7166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15096 SAM JACKSON RD
-----------------------------------------------------
City | BOGALUSA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70427-0624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-335-7166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. PAMELA B REID
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 985-335-7166
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------