Provider Demographics
NPI:1043192982
Name:REED, DEMETRIA NICOLE (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:NICOLE
Last Name:REED
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 GLADSTONE LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5949
Mailing Address - Country:US
Mailing Address - Phone:601-613-5338
Mailing Address - Fax:
Practice Address - Street 1:501 MARSHALL ST STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1687
Practice Address - Country:US
Practice Address - Phone:601-914-9503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS907628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily