Provider Demographics
NPI:1760143374
Name:JENKINS-REESE, PHYLICIA (LVN)
Entity Type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:
Last Name:JENKINS-REESE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 MELROSE LN
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7330
Mailing Address - Country:US
Mailing Address - Phone:713-203-8379
Mailing Address - Fax:
Practice Address - Street 1:1530 MELROSE LN
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7330
Practice Address - Country:US
Practice Address - Phone:713-203-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1009164164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse