Healthcare Provider Details

I. General information

NPI: 1225967193
Provider Name (Legal Business Name): ZACHARY RYAN REAVES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N CHRIS TER
MUSTANG OK
73064-6313
US

IV. Provider business mailing address

316 N CHRIS TER
MUSTANG OK
73064-6313
US

V. Phone/Fax

Practice location:
  • Phone: 405-834-2065
  • Fax:
Mailing address:
  • Phone: 405-834-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number229976
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: