Provider Demographics
NPI:1104476423
Name:REESE, ANAIDRA L (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANAIDRA
Middle Name:L
Last Name:REESE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2079 S EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6942
Mailing Address - Country:US
Mailing Address - Phone:334-559-5071
Mailing Address - Fax:334-203-9451
Practice Address - Street 1:2079 S EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-6942
Practice Address - Country:US
Practice Address - Phone:334-559-5071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183267363LF0000X
TX1060455363LF0000X
GAGAA-NP000660363LF0000X
FLAPRN11018700363LF0000X
AL1-145365363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care