Healthcare Provider Details

I. General information

NPI: 1629987797
Provider Name (Legal Business Name): BLANCA ESMERALDA REYES FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 BEAMAN ST STE 100
CLINTON NC
28328-2695
US

IV. Provider business mailing address

3873 NEEDMORE RD
TURKEY NC
28393-8615
US

V. Phone/Fax

Practice location:
  • Phone: 910-590-8050
  • Fax: 910-596-5420
Mailing address:
  • Phone: 910-337-0892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5025423
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: