Provider Demographics
NPI:1184645061
Name:REESE, SHERRY A (FNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:A
Last Name:REESE
Suffix:
Gender:F
Credentials:FNP
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 99335
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0335
Mailing Address - Country:US
Mailing Address - Phone:817-735-2622
Mailing Address - Fax:
Practice Address - Street 1:855 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2553
Practice Address - Country:US
Practice Address - Phone:817-735-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109116363LF0000X
TX601898363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112241807Medicaid
TX82N274OtherBCBS
TX500006413OtherRAILROAD MEDICARE
TX112241801Medicaid
TX112241808Medicaid
TX112241809Medicaid
TX112241808Medicaid
TX500006413OtherRAILROAD MEDICARE
TXS64014Medicare UPIN
TX82N274OtherBCBS
TX112241801Medicaid