Healthcare Provider Details

I. General information

NPI: 1316861669
Provider Name (Legal Business Name): VANESSA REYES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 AVENUE F
DODGE CITY KS
67801-4541
US

IV. Provider business mailing address

1700 AVENUE F
DODGE CITY KS
67801-4541
US

V. Phone/Fax

Practice location:
  • Phone: 620-225-6821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-86108-031
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: