Provider Demographics
NPI:1336325331
Name:CARNES, REVA POYNTER
Entity Type:Individual
Prefix:
First Name:REVA
Middle Name:POYNTER
Last Name:CARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 CARNES LOOP
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42629-6725
Mailing Address - Country:US
Mailing Address - Phone:270-343-3909
Mailing Address - Fax:
Practice Address - Street 1:148 CARNES LOOP
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:KY
Practice Address - Zip Code:42629-6725
Practice Address - Country:US
Practice Address - Phone:270-343-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical