Healthcare Provider Details

I. General information

NPI: 1306544986
Provider Name (Legal Business Name): MATTHEW REESE APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 1ST ST NW
ALBUQUERQUE NM
87102-1529
US

IV. Provider business mailing address

1210 W BRAKER LN
AUSTIN TX
78758-3801
US

V. Phone/Fax

Practice location:
  • Phone: 505-766-5197
  • Fax:
Mailing address:
  • Phone: 512-978-9300
  • Fax: 512-901-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number72176
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1190672
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: