Provider Demographics
NPI:1184637357
Name:REESE, MICHELLE A (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:REESE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4203 GRAND CT
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-9797
Mailing Address - Country:US
Mailing Address - Phone:502-641-9428
Mailing Address - Fax:
Practice Address - Street 1:1002 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3641
Practice Address - Country:US
Practice Address - Phone:186-638-9272
Practice Address - Fax:401-652-9787
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3440P363LF0000X
IN71002155A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71002155AOtherLICENSE NUMBER
KY3440POtherLICENSE NUMBER
KY3440POtherLICENSE NUMBER
KYQ66073Medicare UPIN
IN71002155AOtherLICENSE NUMBER