Jerry Kenneth Reed

Primary specialty

Nursing Home AdministratorTaxonomy code 376G00000X

License

147168 Issued in TX

Practice address

1415 Big Stone Gap Rd
Duncanville, TX 75137-2003

Phone

(469) 297-0430

Fax

(469) 776-5200

NPI assigned

Jul 28, 2019

Last updated

Jul 28, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Graceful Arms Senior Living LLC

  • Assisted Living Facility
  • Duncanville, TX
  • NPI 1649824715
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564272000000",
    "number": "1659925725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 BIG STONE GAP RD",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751372003",
            "telephone_number": "469-297-0430",
            "fax_number": "469-776-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 BIG STONE GAP RD",
            "city": "DUNCANVILLE",
            "state": "TX",
            "postal_code": "751372003",
            "telephone_number": "469-297-0430",
            "fax_number": "469-776-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REED",
        "first_name": "JERRY",
        "middle_name": "KENNETH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-28",
        "last_updated": "2019-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376G00000X",
            "taxonomy_group": "",
            "desc": "Nursing Home Administrator",
            "state": "TX",
            "license": "147168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS STATE ASSISTED LIVING VENDOR/FACILITY ID",
            "identifier": "106818",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@gracefularmssl.com",
            "affiliation": "N",
            "endpointDescription": "Business Email Address",
            "address_1": "1415 Big Stone Gap Rd",
            "city": "Duncanville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "751372003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Remington Pharmacy Inc. (Total Pharmacy)
• Renal Treatment Centers Southeast LP (Duncanville Dialysis)
• Resolute Nursing Solutions Inc (Resolute Nursing Solutions)
• Resolute Nursing Solutions Inc.
• Revitalized Wellness

• Nursing Home Administrator in Duncanville, TX
• Providers in Duncanville, TX by specialty
• Nursing Home Administrator in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.