Provider Demographics
NPI:1073619771
Name:REESE, BEVERLY M (CDE,RD)
Entity Type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:M
Last Name:REESE
Suffix:
Gender:F
Credentials:CDE,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 E CHERRYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4104
Mailing Address - Country:US
Mailing Address - Phone:361-563-5441
Mailing Address - Fax:361-992-3056
Practice Address - Street 1:5283 OLD BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-3908
Practice Address - Country:US
Practice Address - Phone:361-806-5622
Practice Address - Fax:361-806-5601
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT02115133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered