Provider Demographics
NPI:1215216239
Name:REED, KRYSTLE ANN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KRYSTLE
Middle Name:ANN
Last Name:REED
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:KRYSTLE
Other - Middle Name:ANN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:102 GRANDE CTR
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1266
Mailing Address - Country:US
Mailing Address - Phone:573-468-4455
Mailing Address - Fax:573-468-4451
Practice Address - Street 1:102 GRANDE CTR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-1266
Practice Address - Country:US
Practice Address - Phone:573-468-4455
Practice Address - Fax:573-468-4451
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008023052163W00000X
MO2011026804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse