Provider Demographics
NPI:1174190979
Name:REESE, KEVIN (NP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:REESE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392571
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9571
Mailing Address - Country:US
Mailing Address - Phone:469-420-5544
Mailing Address - Fax:
Practice Address - Street 1:4835 LYNDON B JOHNSON FWY STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6001
Practice Address - Country:US
Practice Address - Phone:469-420-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111111363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology