Provider Demographics
NPI:1003391129
Name:REAVES, SARAH KATELYN (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KATELYN
Last Name:REAVES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATELYN
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2003 BRIGHTS VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-7107
Mailing Address - Country:US
Mailing Address - Phone:423-258-1047
Mailing Address - Fax:
Practice Address - Street 1:277 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2810
Practice Address - Country:US
Practice Address - Phone:865-262-9294
Practice Address - Fax:865-262-9295
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3691363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical