Healthcare Provider Details

I. General information

NPI: 1154955235
Provider Name (Legal Business Name): DELICIA BROOKE REEVES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 HIGHWAY 100
CENTERVILLE TN
37033-1139
US

IV. Provider business mailing address

187 REEVES RD
HOHENWALD TN
38462-5013
US

V. Phone/Fax

Practice location:
  • Phone: 931-729-5551
  • Fax: 931-729-5617
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1555
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4176
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: