Provider Demographics
NPI:1558731919
Name:REESE, MATTHEW P (RN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:REESE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2637 EDENBORN AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7042
Mailing Address - Country:US
Mailing Address - Phone:504-579-3811
Mailing Address - Fax:
Practice Address - Street 1:3616 S I 10 SERVICE RD W STE 100
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1884
Practice Address - Country:US
Practice Address - Phone:504-838-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA149101163WC0400X
171M00000X
LA226873363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator