Provider Demographics
NPI:1497724264
Name:REESE, TERRY G (MSN APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:G
Last Name:REESE
Suffix:
Gender:M
Credentials:MSN APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 STATE HIGHWAY 248
Mailing Address - Street 2:SUITE Q456
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9655
Mailing Address - Country:US
Mailing Address - Phone:417-243-2300
Mailing Address - Fax:417-243-2390
Practice Address - Street 1:5571 N GRETNA RD
Practice Address - Street 2:BRANSON VA OUT PATIENT CLINIC
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7287
Practice Address - Country:US
Practice Address - Phone:417-243-2300
Practice Address - Fax:417-243-2390
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132076363LF0000X, 363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424746717Medicaid
S91383Medicare UPIN
000080571Medicare ID - Type Unspecified