1851637839 NPI number — TREVA PICKRELL REEVES CPNP-AC

Table of content: DR. KHURRAM ASHRAF KHAN BDS, DMD (NPI 1073755187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851637839 NPI number — TREVA PICKRELL REEVES CPNP-AC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REEVES
Provider First Name:
TREVA
Provider Middle Name:
PICKRELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP-AC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PICKRELL
Provider Other First Name:
TREVA
Provider Other Middle Name:
TANNER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851637839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 7TH AVE S # ACC400
Provider Second Line Business Mailing Address:
LOWDER BUILDING
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35233-1711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-638-9653
Provider Business Mailing Address Fax Number:
205-638-6128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 7TH AVE S # ACC400
Provider Second Line Business Practice Location Address:
LOWDER BUILDING
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-638-9653
Provider Business Practice Location Address Fax Number:
205-638-6128
Provider Enumeration Date:
12/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  1-115287 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)