Provider Demographics
NPI:1033315296
Name:REED, STACEY ANN (PA- C)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:REED
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14045 N 7TH ST
Mailing Address - Street 2:STE. 1&2
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4388
Mailing Address - Country:US
Mailing Address - Phone:602-866-0961
Mailing Address - Fax:602-866-9820
Practice Address - Street 1:14045 N 7TH ST
Practice Address - Street 2:STE. 1&2
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4388
Practice Address - Country:US
Practice Address - Phone:602-866-0961
Practice Address - Fax:602-866-9820
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3351363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3351Medicare UPIN