Provider Demographics
NPI:1861063703
Name:REED, TRACI DAWN (RN)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:DAWN
Last Name:REED
Suffix:
Gender:F
Credentials:RN
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 145
Mailing Address - Street 2:
Mailing Address - City:DIBBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73031-0145
Mailing Address - Country:US
Mailing Address - Phone:405-568-1037
Mailing Address - Fax:
Practice Address - Street 1:20751 MAY AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-4524
Practice Address - Country:US
Practice Address - Phone:405-568-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist