Provider Demographics
NPI:1528319407
Name:REEVES, KIMBERLY VALLIA (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:VALLIA
Last Name:REEVES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:VALLIA
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:5040 KINSEY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3002
Mailing Address - Country:US
Mailing Address - Phone:903-534-0911
Mailing Address - Fax:903-534-8882
Practice Address - Street 1:5040 KINSEY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3002
Practice Address - Country:US
Practice Address - Phone:903-534-0911
Practice Address - Fax:903-534-8882
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily