Provider Demographics
NPI:1831653328
Name:REESE, SANDRA JENNINE
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JENNINE
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W SEVIER AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3764
Mailing Address - Country:US
Mailing Address - Phone:423-224-3578
Mailing Address - Fax:
Practice Address - Street 1:132 W SEVIER AVE STE 2
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3764
Practice Address - Country:US
Practice Address - Phone:423-224-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered