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General NPI Number Information
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NPI Number | 1467833871
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Entity Type | Individual
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Provider Name | REGAN MARTIN
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Gender | Female
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 2613 S MAIN ST STE D
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City | JOPLIN
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State | MO
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Zip | 64804-2678
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Country | US
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Telephone | 417-553-7920
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Fax |
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Provider Business Mailing Address
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Address Line | 2613 S MAIN ST STE D
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City | JOPLIN
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State | MO
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Zip | 64804-2678
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Country | US
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Telephone | 417-553-7920
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Fax | 877-464-5922
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2019006014
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 76805
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License Number State | KS
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