Healthcare Provider Details

I. General information

NPI: 1083694996
Provider Name (Legal Business Name): AMY L WATSON REESE ARNP MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 KENTUCKY AVE
PADUCAH KY
42003-3813
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6879
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-0982
  • Fax: 502-588-0987
Mailing address:
  • Phone: 502-559-9378
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number1072072
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: