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NPI Code Detail

MEDICARE: MRS. KATHLEEN M. REAGAN P.A.-C

MEDICARE: MRS. KATHLEEN M. REAGAN P.A.-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant100973NC

General Provider Information

NPI Number : 1407907454
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHLEEN M. REAGAN P.A.-C
Provider Business Mailing Address
First Line : 806 HAY ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28305-5312
Country : US
Telephone Number : 910-860-7008
Fax Number : 910-221-9006
Provider Business Practice Location Address
First Line : 806 HAY ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28305-5312
Country : US
Telephone Number : 910-860-7008
Fax Number : 910-221-9006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2007
Last Update Date : 02/03/2020

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Directions to “ MRS. KATHLEEN M. REAGAN P.A.-C” Practice Location

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