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General NPI Number Information
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NPI Number | 1407992795
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Entity Type | Individual
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Provider Name | KELLY DAWN REID RN
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1708 SPRUCE DR
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City | HIGH RIDGE
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State | MO
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Zip | 63049-1867
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Country | US
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Telephone | 636-677-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 SPRUCE DR
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City | HIGH RIDGE
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State | MO
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Zip | 63049-1867
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Country | US
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Telephone | 636-677-6744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WA2000X
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Taxonomy Name | Administrator Registered Nurse
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License Number | 130624
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163WC1400X
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Taxonomy Name | College Health Registered Nurse
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License Number | 130624
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License Number State | MO
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