Provider Demographics
NPI:1295824795
Name:REESE, TRACY A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:A
Last Name:REESE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1722 SHAFFER ST.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048
Mailing Address - Country:US
Mailing Address - Phone:269-226-5197
Mailing Address - Fax:269-552-0910
Practice Address - Street 1:1722 SHAFFER STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048
Practice Address - Country:US
Practice Address - Phone:269-226-5197
Practice Address - Fax:269-552-0910
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004897363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601004897OtherMICHIGAN LICENSE