=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992814495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REGINA KRISTINE CAVANAUGH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 509 MEDICAL CENTER ROAD
-----------------------------------------------------
City | FORT HOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76544-4752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-287-1866
-----------------------------------------------------
Fax | 254-286-7629
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 MEDICAL CENTER ROAD
-----------------------------------------------------
City | FORT HOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76544-4752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-287-1866
-----------------------------------------------------
Fax | 254-286-7629
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | J4031
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------