Healthcare Provider Details

I. General information

NPI: 1194304121
Provider Name (Legal Business Name): ANN TOOLEY REAVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 308
RALEIGH NC
27607-7514
US

IV. Provider business mailing address

110 BEECHTREE TRL
KITTRELL NC
27544-9323
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-7450
  • Fax:
Mailing address:
  • Phone: 252-425-7237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTOOL-9JS924
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2025-01942
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: