Provider Demographics
NPI:1922680289
Name:REESE, JESSIE LEE (LVN)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:LEE
Last Name: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 1:1509 FARM ROAD 1510
Mailing Address - Street 2:
Mailing Address - City:BROOKSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75421-2749
Mailing Address - Country:US
Mailing Address - Phone:903-517-1104
Mailing Address - Fax:
Practice Address - Street 1:1509 FARM ROAD 1510
Practice Address - Street 2:
Practice Address - City:BROOKSTON
Practice Address - State:TX
Practice Address - Zip Code:75421-2749
Practice Address - Country:US
Practice Address - Phone:903-517-1104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008100164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse