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NPI Code Detail

MEDICARE: JAYNE REAGOR RN

MEDICARE: JAYNE REAGOR RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorRN0000098294TN

General Provider Information

NPI Number : 1003993999
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAYNE REAGOR RN
Provider Business Mailing Address
First Line : 1570 HARBERT AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-5033
Country : US
Telephone Number : 901-230-1570
Fax Number :
Provider Business Practice Location Address
First Line : 210 MANOR ST
Second Line :
City : MARION
State : AR
Zip : 72364-1936
Country : US
Telephone Number : 870-739-6818
Fax Number : 870-739-1970
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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