Individual
TRACY B REEVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
110 NNPTC CIR, GOOSE CREEK, SC 29445-6314
(843) 794-6840
(843) 794-6036
Mailing address
110 NNPTC CIR, GOOSE CREEK, SC 29445-6314
(843) 636-1765
(843) 794-6036
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
648
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0682PA
—
SC
01
—
P00846491
RR - MEDICARE#
SC
Enumeration date
05/14/2007
Last updated
05/28/2024
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