Provider Demographics
NPI:1174065817
Name:REEDER, ALLIX (PA-C)
Entity type:Individual
Prefix:
First Name:ALLIX
Middle Name:
Last Name:REEDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLIX
Other - Middle Name:
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:P.O. BOX 52948
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2948
Mailing Address - Country:US
Mailing Address - Phone:865-306-5708
Mailing Address - Fax:865-584-7712
Practice Address - Street 1:9430 PARK WEST BLVD STE 310
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4203
Practice Address - Country:US
Practice Address - Phone:865-690-5263
Practice Address - Fax:865-588-3740
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3146363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I973966OtherMEDICARE
TNQ026756Medicaid