Provider Demographics
NPI:1871745364
Name:REED, ARDIS ANN (MPH RD LD CDE)
Entity type:Individual
Prefix:MISS
First Name:ARDIS
Middle Name:ANN
Last Name:REED
Suffix:
Gender:F
Credentials:MPH RD LD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 RODGER BROOKE DR. FORT SAM
Mailing Address - Street 2:MCHE-QD/CREDENTIALS BROOKE ARMY MEDICAL CENTER
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6200
Mailing Address - Country:US
Mailing Address - Phone:210-916-2460
Mailing Address - Fax:210-916-5102
Practice Address - Street 1:3851 RODGER BROOKE DR. FORT SAM
Practice Address - Street 2:MCHE-QD/CREDENTIALS BROOKE ARMY MEDICAL CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-916-2460
Practice Address - Fax:210-916-5102
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT07150133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT07150OtherLICENSED DIETITIAN
IL2051-0318OtherCERTIFIED DIABETIC EDUCATOR-NATIONAL CERTIFICATION BOARD FOR DIABETIC EDUCATORS
IL886470OtherREGISTERED DIETITIAN- COMMISSION ON DIETETIC REGISTRATION