Healthcare Provider Details

I. General information

NPI: 1205760428
Provider Name (Legal Business Name): KAITLYN BREANNE REEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S MONTGOMERY AVE
SHEFFIELD AL
35660-6367
US

IV. Provider business mailing address

71 COUNTY ROAD 57
BELMONT MS
38827-8711
US

V. Phone/Fax

Practice location:
  • Phone: 256-386-4196
  • Fax:
Mailing address:
  • Phone: 256-460-9307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number923694
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: