Provider Demographics
NPI:1568946689
Name:REEVES, KAREN LYNNE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNNE
Last Name:REEVES
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1798
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-1798
Mailing Address - Country:US
Mailing Address - Phone:706-295-6485
Mailing Address - Fax:706-802-5506
Practice Address - Street 1:1 JACKSON HILL DR NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5205
Practice Address - Country:US
Practice Address - Phone:706-295-6485
Practice Address - Fax:706-802-5506
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered