Provider Demographics
NPI:1609984442
Name:REED, JESSICA (CNM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REED
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:REED-ELAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 MERCY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL CAMP PENDLETON
Practice Address - Street 2:200 MERCY CIRCLE
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-0000
Practice Address - Country:US
Practice Address - Phone:760-725-1090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1645367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101240Medicaid
CAGR0101241Medicaid