Provider Demographics
NPI:1912482688
Name:REAVIS, LINDSAY RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RENEE
Last Name:REAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LINDSAY
Other - Middle Name:RENEE
Other - Last Name:NOWLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 SAINT ELIZABETH BLVD STE 5000
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1282
Mailing Address - Country:US
Mailing Address - Phone:618-567-1910
Mailing Address - Fax:
Practice Address - Street 1:3 SAINT ELIZABETH BLVD STE 5000
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1282
Practice Address - Country:US
Practice Address - Phone:618-567-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018031882363LF0000X
IL209024625363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily