=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295149086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSHUA ALAN REED NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2014
-----------------------------------------------------
Last Update Date | 04/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 S OLIVER ST STE A
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-2351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-768-7243
-----------------------------------------------------
Fax | 888-365-6743
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10822 SW 86TH TER
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67010-8019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-768-7243
-----------------------------------------------------
Fax | 888-365-6724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 76382
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------