Healthcare Provider Details

I. General information

NPI: 1104227677
Provider Name (Legal Business Name): MCKENZIE REGAN LIKES APN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WEST MAIN
MT STERLING IL
62353
US

IV. Provider business mailing address

108 WEST MAIN
MT STERLING IL
62353
US

V. Phone/Fax

Practice location:
  • Phone: 217-773-6060
  • Fax: 217-406-8319
Mailing address:
  • Phone: 217-773-6060
  • Fax: 217-406-8319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License Number209.011797
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: