Healthcare Provider Details

I. General information

NPI: 1467717009
Provider Name (Legal Business Name): REGINA KATHLEEN FLEMING DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7736 AIRWAYS BLVD
SOUTHAVEN MS
38671-5306
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD
MEMPHIS TN
38120-9401
US

V. Phone/Fax

Practice location:
  • Phone: 662-772-3700
  • Fax:
Mailing address:
  • Phone: 901-227-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number71340
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number31039
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2012020206
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberE-11275
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: