MEDICARE: LATASHA REID

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	163W00000X	Registered Nurse	112721	KY
2	363LF0000X	Family Nurse Practitioner	3012355	KY

General Provider Information

NPI Number	:	1992210165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASHA REID

Provider Business Mailing Address
First Line	:	8019 DIXIE HWY STE 101
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40258-1303
Country	:	US
Telephone Number	:	502-333-3121
Fax Number	:	502-531-9538

Provider Business Practice Location Address
First Line	:	8019 DIXIE HWY STE 101
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40258-1303
Country	:	US
Telephone Number	:	502-333-3121
Fax Number	:	502-531-9538

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

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	08/15/2023

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Directions to “ LATASHA REID ” Practice Location

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