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General NPI Number Information
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NPI Number | 1770773715
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Entity Type | Individual
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Provider Name | KIMBERLY KAY REGNIER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 5571 GRETNA RD
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City | BRANSON
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State | MO
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Zip | 65616-7287
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Country | US
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Telephone | 417-243-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1944
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Country | US
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Telephone | 417-243-2300
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | P-T0713
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | KS15-01578
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License Number State | KS
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