Individual
KELLY REID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-CNP
Contact information
Practice address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
(580) 272-1026
Mailing address
1921 STONECIPHER DR, ADA, OK 74820-3439
(580) 436-3980
(580) 272-1026
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
60112
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60112
LICENSE
OK
Enumeration date
04/27/2011
Last updated
05/21/2014
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