Healthcare Provider Details

I. General information

NPI: 1366361644
Provider Name (Legal Business Name): REAGAN MCKENZIE MUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 FAIRVIEW RD # 333
CHARLOTTE NC
28210-2224
US

IV. Provider business mailing address

6000 FAIRVIEW RD
CHARLOTTE NC
28210-2224
US

V. Phone/Fax

Practice location:
  • Phone: 704-912-1551
  • Fax:
Mailing address:
  • Phone: 704-552-3560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1366361644
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: