=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851112379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REGAN HANCOCK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2024
-----------------------------------------------------
Last Update Date | 02/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 713 W MAIN ST
-----------------------------------------------------
City | ELKTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42220-9229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-265-5353
-----------------------------------------------------
Fax | 270-265-5350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 331 N ABBEY WAY
-----------------------------------------------------
City | HOPKINSVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42240-9441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-839-7205
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 4005962
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------