Provider Demographics
NPI:1053755926
Name:REIS, JESSICA ANN (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:REIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:401 E CHESTNUT ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5700
Mailing Address - Country:US
Mailing Address - Phone:502-588-4425
Mailing Address - Fax:502-588-4427
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 610
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-588-4450
Practice Address - Fax:502-588-9539
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2022-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYTP8442084P0800X
IL0361584402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1053755926Medicaid
KY1053755926Medicaid