Healthcare Provider Details

I. General information

NPI: 1518155092
Provider Name (Legal Business Name): LATISA ALANA REEVES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 LINDSEY GABRIEL DR
HENRICO VA
23231-5799
US

IV. Provider business mailing address

2009 LINDSEY GABRIEL DR
HENRICO VA
23231-5799
US

V. Phone/Fax

Practice location:
  • Phone: 631-398-9200
  • Fax:
Mailing address:
  • Phone: 631-398-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024197720
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: