Provider Demographics
NPI:1962188656
Name:REESER, AMY RAE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:RAE
Last Name:REESER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 W STATE ROAD 205
Mailing Address - Street 2:
Mailing Address - City:SOUTH WHITLEY
Mailing Address - State:IN
Mailing Address - Zip Code:46787-9683
Mailing Address - Country:US
Mailing Address - Phone:260-503-7092
Mailing Address - Fax:
Practice Address - Street 1:2700 LAFAYETTE ST STE 110
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806-1100
Practice Address - Country:US
Practice Address - Phone:260-266-0780
Practice Address - Fax:260-266-0785
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF06230039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily