MEDICARE: BRANDON ALLEN REESE NP

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
1	363L00000X	Nurse Practitioner	854083	NV
2	363LF0000X	Family Nurse Practitioner	854083	NV

General Provider Information

NPI Number	:	1619616687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON ALLEN REESE NP

Provider Business Mailing Address
First Line	:	8461 FARM RD # 120-274
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-8305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8461 FARM RD # 120-274
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-8305
Country	:	US
Telephone Number	:	305-563-0504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2022
Last Update Date	:	01/17/2023

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