Provider Demographics
NPI:1528880192
Name:MOOSE, REECE (PA-C)
Entity type:Individual
Prefix:
First Name:REECE
Middle Name:
Last Name:MOOSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REECE
Other - Middle Name:OLIVIA
Other - Last Name:BUMGARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:236 BEAM LANE
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28678
Mailing Address - Country:US
Mailing Address - Phone:828-514-0538
Mailing Address - Fax:
Practice Address - Street 1:130 1ST ST W
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2106
Practice Address - Country:US
Practice Address - Phone:828-732-7450
Practice Address - Fax:828-732-7451
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant