Provider Demographics
NPI:1295519593
Name:REEVES, KIM NICOLE
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:NICOLE
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:NICOLE
Other - Last Name:CROWNOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1748 CHRISTIANA DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6268
Mailing Address - Country:US
Mailing Address - Phone:770-910-0014
Mailing Address - Fax:
Practice Address - Street 1:1748 CHRISTIANA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-6268
Practice Address - Country:US
Practice Address - Phone:770-910-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83680374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula