Healthcare Provider Details

I. General information

NPI: 1265751671
Provider Name (Legal Business Name): ROBERT CARL REEVES APRN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BEECH ST
CENTERVILLE TN
37033-1101
US

IV. Provider business mailing address

601 BEECH ST
CENTERVILLE TN
37033-1101
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14115
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: