Provider Demographics
NPI:1447435615
Name:REAVES, AMY STANTON (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:STANTON
Last Name:REAVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2880 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9171
Mailing Address - Country:US
Mailing Address - Phone:843-797-5050
Mailing Address - Fax:843-797-3633
Practice Address - Street 1:2880 TRICOM ST
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9171
Practice Address - Country:US
Practice Address - Phone:843-797-5050
Practice Address - Fax:843-797-3633
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1285363A00000X, 363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC13347593OtherMULTIPLAN PROVIDER NO.
SCP01337502OtherRAILROAD MEDICARE PTAN
SC0631PAMedicaid
SCD043OtherARCIS HEALTHCARE GROUP MEDICARE PTAN
SC1902246077OtherARCIS HEALTHCARE GROUP NPI NO.
SC983747OtherWELLCARE PROVIDER ID NO.
SCDU4331OtherARCIS HEALTHCARE GROUP RAILROAD MEDICARE PTAN
SC2864256OtherUNITED HEALTHCARE MPIN NO.
SC45168OtherARCIS HEALTHCARE MULTIPLAN GROUP NO.
SC4920537OtherAETNA PIN NO.
SCGP6337OtherARCIS HEALTHCARE GROUP MEDICAID LEGACY NO.
SC46-2535418OtherARCIS HEALTHCARE GROUP TIN
SCAA26871701Medicare PIN
SCGP6337OtherARCIS HEALTHCARE GROUP MEDICAID LEGACY NO.