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General NPI Number Information
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NPI Number | 1699949016
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Entity Type | Individual
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Provider Name | TAMMY DEAN REID RN, BSN
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Gender | Female
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 1500 N WESTWOOD BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3318
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Country | US
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Telephone | 573-778-4696
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Fax | 573-778-4699
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Provider Business Mailing Address
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Address Line | 1500 N WESTWOOD BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3318
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Country | US
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Telephone | 573-778-4696
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Fax | 573-778-4699
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 119498
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License Number State | MO
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