Individual
JERRY KENNETH REED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1415 BIG STONE GAP RD, DUNCANVILLE, TX 75137-2003
(469) 297-0430
(469) 776-5200
Mailing address
1415 BIG STONE GAP RD, DUNCANVILLE, TX 75137-2003
(469) 297-0430
(469) 776-5200
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
147168
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106818
TEXAS STATE ASSISTED LIVING VENDOR/FACILITY ID
TX
Enumeration date
07/28/2019
Last updated
07/28/2019
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