Provider Demographics
NPI:1033643036
Name:REEVES, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:REEVES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:LYNNE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1254 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-5442
Mailing Address - Country:US
Mailing Address - Phone:402-270-2898
Mailing Address - Fax:
Practice Address - Street 1:1254 40TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-5442
Practice Address - Country:US
Practice Address - Phone:402-270-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 372600000X, 372500000X
NE374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide