MEDICARE: MAEGAN RICHELLE REID PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2026028097	MO

General Provider Information

NPI Number	:	1891620068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAEGAN RICHELLE REID PMHNP-BC

Provider Business Mailing Address
First Line	:	10987 HIGHWAY KK
Second Line	:
City	:	CROCKER
State	:	MO
Zip	:	65452-7329
Country	:	US
Telephone Number	:	573-466-2319
Fax Number	:

Provider Business Practice Location Address
First Line	:	752 BAGNELL DAM BLVD STE B
Second Line	:
City	:	LAKE OZARK
State	:	MO
Zip	:	65049-8716
Country	:	US
Telephone Number	:	573-466-2319
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/18/2026

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