MEDICARE: MRS. KAYLEA M REEVES APN

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	364SA2200X	Adult Health Clinical Nurse Specialist	277002156	IL
2	363LA2200X	Adult Health Nurse Practitioner	209024506	IL

General Provider Information

NPI Number	:	1881101350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYLEA M REEVES APN

Provider Business Mailing Address
First Line	:	2160 S 1ST AVE DEPT OF
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153-3328
Country	:	US
Telephone Number	:	708-216-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	19710 GOVERNORS HWY STE 2
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-2081
Country	:	US
Telephone Number	:	708-480-9730
Fax Number	:

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

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	06/25/2024

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