Provider Demographics
NPI:1124289582
Name:REESE, AMANDA HALE (DO)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:HALE
Last Name:REESE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-778-7812
Mailing Address - Fax:
Practice Address - Street 1:110 HUFFARD DR
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-9209
Practice Address - Country:US
Practice Address - Phone:276-322-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116020743208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026948Medicaid
VA1124289582Medicaid
VAVVC053AMedicare PIN
WVWV3262AMedicare PIN