Provider Demographics
NPI:1215011028
Name:REIVES, VONDA (FNP-C)
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:
Last Name:REIVES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S MIDDLETON ST
Mailing Address - Street 2:
Mailing Address - City:ROBBINS
Mailing Address - State:NC
Mailing Address - Zip Code:27325-8407
Mailing Address - Country:US
Mailing Address - Phone:910-948-2059
Mailing Address - Fax:910-948-2443
Practice Address - Street 1:301 S MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:ROBBINS
Practice Address - State:NC
Practice Address - Zip Code:27325-8407
Practice Address - Country:US
Practice Address - Phone:910-948-2059
Practice Address - Fax:910-948-2443
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201805363L00000X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC080153048OtherRR MEDICARE-SANFORD
NC51232OtherMEDCOST-SANFORD
NC8984267Medicaid
NC84267OtherBCBS
NC080065783OtherRR MEDICARE-PITTSBORO
NC31985OtherMEDCOST-PITTSBORO
NC202654GMedicare ID - Type UnspecifiedSANFORD
NC8984267Medicaid
NC84267OtherBCBS