Basic Information
Provider Information | |||||||||
NPI: | 1285364703 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | REEVES | ||||||||
FirstName: | LISA | ||||||||
MiddleName: | DIANE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WELLS | ||||||||
OtherFirstName: | LISA | ||||||||
OtherMiddleName: | REEVES | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 621 | ||||||||
Address2: |   | ||||||||
City: | LEICESTER | ||||||||
State: | NC | ||||||||
PostalCode: | 287480621 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8286063915 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4 VANDERBILT PARK DR STE 100 | ||||||||
Address2: |   | ||||||||
City: | ASHEVILLE | ||||||||
State: | NC | ||||||||
PostalCode: | 288032476 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8282580397 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/16/2022 | ||||||||
LastUpdateDate: | 06/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/21/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | WELL-LQEXB | NC | Y |   | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.