Healthcare Provider Details

I. General information

NPI: 1154110211
Provider Name (Legal Business Name): REAGAN WILD HANKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MONROE STATION RD
MONROEVILLE AL
36460-1450
US

IV. Provider business mailing address

26 MONROE STATION RD
MONROEVILLE AL
36460-1450
US

V. Phone/Fax

Practice location:
  • Phone: 251-227-3484
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-178904
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: