Healthcare Provider Details

I. General information

NPI: 1609299213
Provider Name (Legal Business Name): REAGAN GAGNON PA-C, CAQ-PSY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EAST ST
CARLISLE MA
01741-1105
US

IV. Provider business mailing address

134 EAST ST
CARLISLE MA
01741-1105
US

V. Phone/Fax

Practice location:
  • Phone: 415-509-4237
  • Fax:
Mailing address:
  • Phone: 415-509-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5561
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1426
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3681
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: