Basic Information
| Provider Information | |||||||||
| NPI: | 1881328938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REEVES | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | CLAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1908 KEYTOWN RD | ||||||||
| Address2: | |||||||||
| City: | DE KALB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393287700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014162414 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2124 14TH ST | ||||||||
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| City: | MERIDIAN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 393014040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015536000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2022 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 903804 | MS | N | Nursing Service Providers | Registered Nurse | 367500000X | 901795 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.