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NPI Code Detail

MEDICARE: REESEY RUSSELL FNP-C

MEDICARE: REESEY RUSSELL FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner220773OK

General Provider Information

NPI Number : 1013726991
Entity Type Code : Individual
Provider Name (Legal Business Name) : REESEY RUSSELL FNP-C
Provider Business Mailing Address
First Line : 730 E TAFT AVE
Second Line :
City : SAPULPA
State : OK
Zip : 74066-5766
Country : US
Telephone Number : 918-224-7305
Fax Number :
Provider Business Practice Location Address
First Line : 730 E TAFT AVE
Second Line :
City : SAPULPA
State : OK
Zip : 74066-5766
Country : US
Telephone Number : 940-704-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2025
Last Update Date : 03/15/2025

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