Provider Demographics
NPI:1134761489
Name:REEVES, KALIAH A (CRNP)
Entity type:Individual
Prefix:
First Name:KALIAH
Middle Name:A
Last Name:REEVES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6701
Mailing Address - Country:US
Mailing Address - Phone:814-231-7000
Mailing Address - Fax:814-238-0790
Practice Address - Street 1:2051 S ATHERTON ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7608
Practice Address - Country:US
Practice Address - Phone:844-278-4600
Practice Address - Fax:814-231-6879
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty