MEDICARE: LATISA ALANA REEVES PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1283258	VA

General Provider Information

NPI Number	:	1518155092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATISA ALANA REEVES PMHNP-BC

Provider Business Mailing Address
First Line	:	2009 LINDSEY GABRIEL DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23231-5799
Country	:	US
Telephone Number	:	631-398-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 LINDSEY GABRIEL DR
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23231-5799
Country	:	US
Telephone Number	:	631-398-9200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	05/20/2026

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