Provider Demographics
NPI:1518142371
Name:REYES, JOHN (RN, MSN, ACNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:REYES
Suffix:
Gender:M
Credentials:RN, MSN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 FANNIN
Mailing Address - Street 2:ALKEK 754
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-441-4565
Mailing Address - Fax:
Practice Address - Street 1:3275 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4501
Practice Address - Country:US
Practice Address - Phone:346-220-8063
Practice Address - Fax:832-838-4362
Is Sole Proprietor?:No
Enumeration Date:2007-12-29
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA267815363LA2100X
TX783952363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0717282Medicaid
MA000419801Medicare PIN