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General NPI Number Information
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NPI Number | 1124617923
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Entity Type | Individual
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Provider Name | ROMAN RAY REYES FNP-C, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 200 E ARIZONA AVE
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City | SWEETWATER
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State | TX
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Zip | 79556-7120
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Country | US
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Telephone | 325-235-1701
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 STANLEY ST
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City | SWEETWATER
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State | TX
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Zip | 79556-1920
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Country | US
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Telephone | 325-338-8783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2024004990
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 1019364
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License Number State | TX
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