Provider Demographics
NPI:1417683731
Name:REYES, JESSICA (DOULA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5869 PIPERS GREEN LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-1526
Mailing Address - Country:US
Mailing Address - Phone:901-300-6338
Mailing Address - Fax:
Practice Address - Street 1:5869 PIPERS GREEN LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-1526
Practice Address - Country:US
Practice Address - Phone:901-229-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN220005895374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty