1780568857 NPI number — MRS. KRISTEN NICHOLE REESER CPRC

Table of content: MRS. KRISTEN NICHOLE REESER CPRC (NPI 1780568857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780568857 NPI number — MRS. KRISTEN NICHOLE REESER CPRC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REESER
Provider First Name:
KRISTEN
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPRC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARTER
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780568857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
946 WOODLAWN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIAVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48421-9768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-322-0854
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
946 WOODLAWN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIAVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48421-9768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-322-0854
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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