Healthcare Provider Details

I. General information

NPI: 1538463559
Provider Name (Legal Business Name): SALLY DYAN REESE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W 34TH ST STE 301
AUSTIN TX
78705-1217
US

IV. Provider business mailing address

902 CRYSTAL FALLS PKWY
LEANDER TX
78641-3646
US

V. Phone/Fax

Practice location:
  • Phone: 512-212-4670
  • Fax: 512-233-5830
Mailing address:
  • Phone: 512-259-2222
  • Fax: 512-259-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP119703
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAP13118
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: