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General NPI Number Information
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NPI Number | 1972950285
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Entity Type | Individual
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Provider Name | KARA TRAPP REARDON M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 350 REDSTONE AVE W
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City | CRESTVIEW
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State | FL
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Zip | 32536-6433
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Country | US
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Telephone | 850-689-1740
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Fax | 850-682-6652
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Provider Business Mailing Address
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Address Line | 350 REDSTONE AVE W
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City | CRESTVIEW
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State | FL
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Zip | 32536-6433
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Country | US
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Telephone | 850-689-1740
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Fax | 850-682-6652
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LP03604
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME133359
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME133359
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License Number State | OK
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