Healthcare Provider Details

I. General information

NPI: 1831024041
Provider Name (Legal Business Name): GWENN HORTENSE REEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16441 S HARRELLS FERRY RD APT 5505
BATON ROUGE LA
70816-7537
US

IV. Provider business mailing address

16441 S HARRELLS FERRY RD APT 5505
BATON ROUGE LA
70816-7537
US

V. Phone/Fax

Practice location:
  • Phone: 504-421-3038
  • Fax:
Mailing address:
  • Phone: 504-421-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: