Healthcare Provider Details

I. General information

NPI: 1568975761
Provider Name (Legal Business Name): REEVES MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 E CENTERTON BLVD
CENTERTON AR
72719
US

IV. Provider business mailing address

1415 E CENTERTON BLVD
CENTERTON AR
72719-7050
US

V. Phone/Fax

Practice location:
  • Phone: 479-224-1565
  • Fax: 844-758-8644
Mailing address:
  • Phone: 479-224-1565
  • Fax: 844-758-8644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLYN R REEVES
Title or Position: PHYSICIAN/OWNER
Credential: D.O.
Phone: 479-224-1565