Provider Demographics
NPI:1255331245
Name:REEVES, SHARON A (FNP-C)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:REEVES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 LIVE OAK ST
Practice Address - Street 2:YOUTH & FAMILY CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6153
Practice Address - Country:US
Practice Address - Phone:214-266-1257
Practice Address - Fax:214-266-1258
Is Sole Proprietor?:No
Enumeration Date:2005-07-30
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137795418Medicaid
TX137795414Medicaid
TX137795420Medicaid
TX137795412Medicaid
TX137795417Medicaid
TX137795415Medicaid
TX137795419Medicaid
TX137795421Medicaid
TX137795422Medicaid
TX8N9427OtherBLUE CROSS & BLUE SHIELD
TX137795413Medicaid
TX137795416Medicaid
TX8N9427OtherBLUE CROSS & BLUE SHIELD
TX137795414Medicaid