Provider Demographics
NPI:1639548738
Name:REEVES, ALICIA M (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:REEVES
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:NUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:8444 W 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1752
Mailing Address - Country:US
Mailing Address - Phone:316-721-9500
Mailing Address - Fax:
Practice Address - Street 1:8444 W 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1752
Practice Address - Country:US
Practice Address - Phone:316-721-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76949363L00000X
KS53-76949-061163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS003719414OtherMEDICARE