Provider Demographics
NPI:1790856904
Name:REEVES, KATHY LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:REEVES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:REEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:35 W LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7253
Mailing Address - Country:US
Mailing Address - Phone:205-226-5900
Mailing Address - Fax:205-226-5937
Practice Address - Street 1:35 W LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-7253
Practice Address - Country:US
Practice Address - Phone:205-226-5900
Practice Address - Fax:205-226-5937
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-028781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF020OtherSNEAD MEDICARE GROUP #
ALD729OtherONEONTA MC GROUP#
AL891005390Medicaid
AL51553048Medicare ID - Type Unspecified
ALF020OtherSNEAD MEDICARE GROUP #