MEDICARE: JACQUELINE R REID CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	16962	TN
2	367A00000X	Advanced Practice Midwife

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01127642	OTHER	TN	PALMETTO GBA PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760731723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE R REID CNM

Provider Business Mailing Address
First Line	:	3841 GREEN HILLS VILLAGE DR STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 THE VANDERBILT CLINIC
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-2428
Country	:	US
Telephone Number	:	615-936-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2012
Last Update Date	:	03/31/2022

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