Provider Demographics
NPI:1255875886
Name:REAM, JESSE
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:REAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 E. GREENWAY PLAZA
Mailing Address - Street 2:SUITE 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0924
Mailing Address - Country:US
Mailing Address - Phone:713-335-1733
Mailing Address - Fax:713-491-4677
Practice Address - Street 1:2131 SW 336TH STREET
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2847
Practice Address - Country:US
Practice Address - Phone:713-335-1733
Practice Address - Fax:713-491-4677
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60701530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily