Provider Demographics
NPI:1427742667
Name:REEVES, GINA (RD, LD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:REEVES
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 ROCKHILL RD APT 1
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-1514
Mailing Address - Country:US
Mailing Address - Phone:816-813-7225
Mailing Address - Fax:
Practice Address - Street 1:2551 NORTERRE CIR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3412
Practice Address - Country:US
Practice Address - Phone:816-463-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021049802133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered