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General NPI Number Information
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NPI Number | 1972952166
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Entity Type | Individual
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Provider Name | KAITLYN REEVES APRN
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Gender | Female
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 520 E NORTHWEST HWY SUITE 102
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City | GRAPEVINE
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State | TX
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Zip | 76051-6297
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Country | US
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Telephone | 817-328-1922
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Fax |
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Provider Business Mailing Address
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Address Line | 15678 KNOLL TRAIL DR APT 1214
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City | DALLAS
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State | TX
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Zip | 75248-7001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP131071
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License Number State | TX
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