Provider Demographics
NPI:1780568857
Name:REESER, KRISTEN NICHOLE (CPRC)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:NICHOLE
Last Name:REESER
Suffix:
Gender:F
Credentials:CPRC
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:NICHOLE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:946 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48421-9768
Mailing Address - Country:US
Mailing Address - Phone:810-322-0854
Mailing Address - Fax:
Practice Address - Street 1:946 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:COLUMBIAVILLE
Practice Address - State:MI
Practice Address - Zip Code:48421-9768
Practice Address - Country:US
Practice Address - Phone:810-322-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist