Healthcare Provider Details

I. General information

NPI: 1992235329
Provider Name (Legal Business Name): VICTORIA LYNN REGAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 ATHERHOLT RD
LYNCHBURG VA
24501-2184
US

IV. Provider business mailing address

2405 ATHERHOLT RD
LYNCHBURG VA
24501-2184
US

V. Phone/Fax

Practice location:
  • Phone: 434-485-8590
  • Fax:
Mailing address:
  • Phone: 434-485-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059066
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009585
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: