Provider Demographics
NPI:1497803811
Name:REESE, REBECCA RUTH (CNS, APRN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RUTH
Last Name:REESE
Suffix:
Gender:F
Credentials:CNS, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 W FORT WORTH PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3444
Mailing Address - Country:US
Mailing Address - Phone:918-258-1188
Mailing Address - Fax:918-258-1188
Practice Address - Street 1:1923 S UTICA AVE
Practice Address - Street 2:DAVIS TOWER, STE 400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-748-1395
Practice Address - Fax:918-293-3144
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0034048364SR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SR0400XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200064330AMedicaid
OK200064330AMedicaid
OKQ19411Medicare UPIN