Provider Demographics
NPI:1508567975
Name:REESE, SHIRLEY TERESA X (NP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:TERESA
Last Name:REESE
Suffix:X
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 W FIVE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-9364
Mailing Address - Country:US
Mailing Address - Phone:803-634-3616
Mailing Address - Fax:
Practice Address - Street 1:730 W FIVE NOTCH RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-9364
Practice Address - Country:US
Practice Address - Phone:803-634-3616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily