Provider Demographics
NPI:1689053043
Name:REEVES, NICHOL JANEL (APRN ANP-C)
Entity Type:Individual
Prefix:
First Name:NICHOL
Middle Name:JANEL
Last Name:REEVES
Suffix:
Gender:F
Credentials:APRN ANP-C
Other - Prefix:
Other - First Name:NICHOL
Other - Middle Name:JANEL
Other - Last Name:FOUNTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-261-4834
Mailing Address - Fax:314-383-3970
Practice Address - Street 1:23 SAINT STANISLAUS CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-6540
Practice Address - Country:US
Practice Address - Phone:314-306-7107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013041944363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health