Healthcare Provider Details

I. General information

NPI: 1417819715
Provider Name (Legal Business Name): MIKAYLA REEVES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 FARNAM ST
OMAHA NE
68131-2806
US

IV. Provider business mailing address

112 E SLOUP DR
WAHOO NE
68066-2519
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2000
  • Fax:
Mailing address:
  • Phone: 402-443-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number3335
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: