Provider Demographics
NPI:1750374336
Name:REAVIS, CATHERINE W (FNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:W
Last Name:REAVIS
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 1:110 R T STANLEY SR PL
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436
Mailing Address - Country:US
Mailing Address - Phone:912-526-9355
Mailing Address - Fax:912-526-4783
Practice Address - Street 1:110 R T STANLEY SR PL
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436
Practice Address - Country:US
Practice Address - Phone:912-526-9355
Practice Address - Fax:912-526-4783
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155029 NP363L00000X
TXAP108269363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBFLWMedicare ID - Type Unspecified
S86151Medicare UPIN