Provider Demographics
NPI:1992877708
Name:REED, KELLY L (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:L
Last Name:REED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KELLY
Other - Middle Name:LOUISE
Other - Last Name:REED-ZECHERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:360-293-4343
Mailing Address - Fax:360-588-1587
Practice Address - Street 1:4445 E BAY DR STE 210
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6865
Practice Address - Country:US
Practice Address - Phone:727-725-6110
Practice Address - Fax:727-669-9742
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032070207R00000X
IN01073158A207R00000X
CAA65127207R00000X
RIMD09235207R00000X
ORMD184261207R00000X
FLME149520207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201190130Medicaid
00A651271Medicare ID - Type Unspecified
IN201190130Medicaid
IN182790003Medicare UPIN
G34759Medicare UPIN