Provider Demographics
NPI:1932429248
Name:REESE, BRENDA RENEA
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:RENEA
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 SONNY'S COVE
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-3926
Mailing Address - Country:US
Mailing Address - Phone:901-635-8701
Mailing Address - Fax:901-635-8701
Practice Address - Street 1:219 SONNYS CV
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-3926
Practice Address - Country:US
Practice Address - Phone:731-635-8701
Practice Address - Fax:731-635-8701
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
TN0007390171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No253Z00000XAgenciesIn Home Supportive Care