Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 20A15550 | CA |
Y | 207N00000X | Dermatologist | OS17445 | FL |
NPI | 1053666370 |
---|---|
Provider Name | Kelly L Reed |
First Address | Gulf Breeze, FL 32561-4468 |
Second Address | Gulf Breeze, FL 32561-4468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 21/05/2021 |