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General NPI Number Information
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NPI Number | 1740828078
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Entity Type | Individual
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Provider Name | LAUREN REAGAN
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Gender | Female
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Dates
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Enumeration Date | 12/17/2019
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Last Update Date | 02/09/2023
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Provider Practice Location Address
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Address Line | 2807 US HIGHWAY 84 E
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City | CAIRO
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State | GA
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Zip | 39828-1371
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Country | US
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Telephone | 229-397-9064
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Fax |
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Provider Business Mailing Address
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Address Line | 654 10TH AVE NW
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City | CAIRO
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State | GA
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Zip | 39828-1955
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN247868
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License Number State | GA
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