Provider Demographics
NPI:1417131426
Name:REASONER, BRIAN (NP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:REASONER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 N. THUNDERBIRD CIRCLE
Mailing Address - Street 2:NEXTCARE URGENT CARE
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1219
Mailing Address - Country:US
Mailing Address - Phone:480-353-2235
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:5369 S. CALLE SANTA CRUZ
Practice Address - Street 2:SUITE 145 NEXTCARE URGENT CARE
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706
Practice Address - Country:US
Practice Address - Phone:520-573-7500
Practice Address - Fax:480-776-0025
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ633076Medicaid