=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356310429
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA A REED M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2006
-----------------------------------------------------
Last Update Date | 12/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2605 KENTUCKY AVE STE 202
-----------------------------------------------------
City | PADUCAH
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42003-3801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-415-4690
-----------------------------------------------------
Fax | 270-415-4691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2605 KENTUCKY AVENUE SUITE 306
-----------------------------------------------------
City | PADUCAH
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42003-3802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-415-7653
-----------------------------------------------------
Fax | 270-575-8359
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 37673
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------