Healthcare Provider Details

I. General information

NPI: 1588992184
Provider Name (Legal Business Name): MIRIAHA D REAMS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 S WILLOW AVE
COOKEVILLE TN
38501-3840
US

IV. Provider business mailing address

758 S WILLOW AVE
COOKEVILLE TN
38501-3840
US

V. Phone/Fax

Practice location:
  • Phone: 931-526-6173
  • Fax: 931-526-5084
Mailing address:
  • Phone: 931-526-6173
  • Fax: 931-526-5084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14544
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: