Provider Demographics
NPI:1588689533
Name:REED, STEPHANIE J (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:REED
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844273
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4273
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:2990 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-2149
Practice Address - Country:US
Practice Address - Phone:903-593-1892
Practice Address - Fax:903-592-3886
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119941363LF0000X
TX794054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-090OtherTRICARE
TX75-2616977-121OtherTRICARE
TX750818167010OtherTRICARE
TX794054OtherRN LICENSE
TXP00925620OtherMEDICARE RR
MR0401036OtherDEA
TXP01062409OtherRAIL ROAD
TX883N46OtherBCBS
TXTIN PLUS 043OtherTRICARE
TX871N14OtherBCBS
TX280118502Medicaid
TX280118503Medicaid
TX45-2578435-001OtherTRICARE
TX836N49OtherBCBS
TX280118501Medicaid
TX45-2578435-002OtherTRICARE
TX836N49OtherBCBS
TXP00110747Medicare PIN
TXP00925620OtherMEDICARE RR
TX45-2578435-002OtherTRICARE