Healthcare Provider Details

I. General information

NPI: 1619545423
Provider Name (Legal Business Name): VALERIE D'NELL REEVE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 06/16/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 S PEACHTREE ST
JASPER TX
75951-4916
US

IV. Provider business mailing address

500 COUNTY ROAD 355
JASPER TX
75951-7230
US

V. Phone/Fax

Practice location:
  • Phone: 409-384-5701
  • Fax:
Mailing address:
  • Phone: 409-381-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number845040
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1044605
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: