Provider Demographics
NPI:1295508349
Name:CLARE, REESER LEEVON (APRN-CNP)
Entity type:Individual
Prefix:
First Name:REESER
Middle Name:LEEVON
Last Name:CLARE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:REESER
Other - Middle Name:LEEVON
Other - Last Name:CLARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:701 CEDAR LAKE BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7815
Mailing Address - Country:US
Mailing Address - Phone:405-445-1210
Mailing Address - Fax:
Practice Address - Street 1:2520 TRIMMIER RD STE 100A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1945
Practice Address - Country:US
Practice Address - Phone:254-390-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty