Provider Demographics
NPI:1538463559
Name:REESE, SALLY DYAN (NP)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:DYAN
Last Name:REESE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:902 CRYSTAL FALLS PKWY
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3646
Mailing Address - Country:US
Mailing Address - Phone:512-259-2222
Mailing Address - Fax:512-259-2290
Practice Address - Street 1:630 W 34TH ST STE 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1217
Practice Address - Country:US
Practice Address - Phone:512-212-4670
Practice Address - Fax:512-233-5830
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP119703363LF0000X
TXAP13118364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily