Provider Demographics
NPI:1124308341
Name:REESOR, JEALENA C (APRN)
Entity type:Individual
Prefix:
First Name:JEALENA
Middle Name:C
Last Name:REESOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 BOONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8816
Mailing Address - Country:US
Mailing Address - Phone:859-744-0067
Mailing Address - Fax:859-744-0042
Practice Address - Street 1:1520 BOONESBORO RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-8816
Practice Address - Country:US
Practice Address - Phone:859-744-0067
Practice Address - Fax:859-744-0042
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1088083163W00000X
KY3007026363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse