Provider Demographics
NPI:1265279418
Name:REEVES, AUDREY LYNN (FNP)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:LYNN
Last Name:REEVES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 PROVIDENCE PARK
Mailing Address - Street 2:
Mailing Address - City:STERLINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:71280-3502
Mailing Address - Country:US
Mailing Address - Phone:318-347-5489
Mailing Address - Fax:
Practice Address - Street 1:3424 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2387
Practice Address - Country:US
Practice Address - Phone:318-690-0662
Practice Address - Fax:318-329-9429
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA236582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily