=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679770713
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CANDACE D. REEVES NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2007
-----------------------------------------------------
Last Update Date | 09/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ARC SOUTHWEST AFTER HOURS 1807 SLAUGHTER LANE, SUITE 490
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78748-6237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-282-8967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | ARC SOUTHWEST 1807 SLAUGHTER LANE, SUITE 490
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78748-6237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-282-8967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | AP108693
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------