Provider Demographics
NPI:1760401426
Name:REESE, JUANA ADKINS (NP-C)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:ADKINS
Last Name:REESE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:Q
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 2197
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-2197
Mailing Address - Country:US
Mailing Address - Phone:901-860-8909
Mailing Address - Fax:
Practice Address - Street 1:346 NEW BYHALIA RD STE 3
Practice Address - Street 2:UNIQUE MEDICAL CENTER
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3741
Practice Address - Country:US
Practice Address - Phone:901-853-1734
Practice Address - Fax:901-854-1166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00328806OtherRAILROAD MEDICARE
MS06428011Medicaid
MSQ62980Medicare UPIN
MSP00328806OtherRAILROAD MEDICARE