Healthcare Provider Details

I. General information

NPI: 1639882350
Provider Name (Legal Business Name): SHARONA REEVES RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 COUNTY ROAD 514
RIENZI MS
38865-9522
US

IV. Provider business mailing address

276 COUNTY ROAD 514
RIENZI MS
38865-9522
US

V. Phone/Fax

Practice location:
  • Phone: 662-643-8420
  • Fax:
Mailing address:
  • Phone: 662-643-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-249207
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: