Basic Information
| Provider Information | |||||||||
| NPI: | 1992015895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REEVES | ||||||||
| FirstName: | CLAY | ||||||||
| MiddleName: | WOODROW | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 S GETTY ST | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317399315 | ||||||||
| FaxNumber: | 2317371808 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 S GETTY ST | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317399315 | ||||||||
| FaxNumber: | 2317371808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2010 | ||||||||
| LastUpdateDate: | 04/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 4704247153 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 4704247153 | 01 | MI | LICENSE | OTHER |