Provider Demographics
NPI:1760516413
Name:REEVES, ANGELA DICKERSON (APRN,BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DICKERSON
Last Name:REEVES
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE #1600
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-226-9193
Mailing Address - Fax:864-231-0281
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE #1600
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-226-9193
Practice Address - Fax:864-231-0281
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC748363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0886Medicaid
SCNP0886Medicaid