MEDICARE: REAGAN KENNETT ARMOUR

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
1	1041C0700X	Clinical Social Worker	PO18811	NC

General Provider Information

NPI Number	:	1801663950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REAGAN KENNETT ARMOUR

Provider Business Mailing Address
First Line	:	1017 TYVOLA RD APT 1309
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3789
Country	:	US
Telephone Number	:	910-524-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	1017 TYVOLA RD APT 1309
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-3789
Country	:	US
Telephone Number	:	910-524-0242
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	12/08/2023

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