Provider Demographics
NPI:1255468880
Name:REEVES, KYLE VINCENT (RN, ATC)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:VINCENT
Last Name:REEVES
Suffix:
Gender:M
Credentials:RN, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 CHINIAK BAY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2362
Mailing Address - Country:US
Mailing Address - Phone:907-222-7525
Mailing Address - Fax:
Practice Address - Street 1:3730 CHINIAK BAY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2362
Practice Address - Country:US
Practice Address - Phone:907-222-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer