Provider Demographics
NPI:1124228382
Name:REEVES, CAROLYN R (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:R
Last Name:REEVES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1415 E CENTERON BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTERON
Mailing Address - State:AR
Mailing Address - Zip Code:72719
Mailing Address - Country:US
Mailing Address - Phone:479-224-1565
Mailing Address - Fax:844-758-8644
Practice Address - Street 1:1415 E CENTERTON BLVD
Practice Address - Street 2:
Practice Address - City:CENTERTON
Practice Address - State:AR
Practice Address - Zip Code:72719-7050
Practice Address - Country:US
Practice Address - Phone:479-224-1565
Practice Address - Fax:844-758-8644
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018887207R00000X
ARE6133207RH0002X, 207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine