Provider Demographics
NPI:1871369017
Name:REEVES, MARSHAY DENITRIA (NP)
Entity type:Individual
Prefix:
First Name:MARSHAY
Middle Name:DENITRIA
Last Name:REEVES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARSHAY
Other - Middle Name:DENITRIA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1668 W PEACE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-5332
Mailing Address - Country:US
Mailing Address - Phone:601-859-5213
Mailing Address - Fax:
Practice Address - Street 1:1668 W PEACE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-5332
Practice Address - Country:US
Practice Address - Phone:601-859-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily