Provider Demographics
NPI:1073999132
Name:REEVES, COURTNEY (AGNP-C)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 BREN RD E
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9664
Mailing Address - Country:US
Mailing Address - Phone:478-841-0837
Mailing Address - Fax:478-254-7350
Practice Address - Street 1:2525 2ND ST
Practice Address - Street 2:SUITE 150
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206
Practice Address - Country:US
Practice Address - Phone:478-254-7353
Practice Address - Fax:478-254-7350
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195497363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner