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NPI Code Detail

MEDICARE: REGAN MAE KOEHN

MEDICARE: REGAN MAE KOEHN
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1306534078
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGAN MAE KOEHN
Provider Business Mailing Address
First Line : 5945 CLIFFDALE RD STE 1111
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28314-0034
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5945 CLIFFDALE RD STE 1111
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28314-0034
Country : US
Telephone Number : 910-229-3951
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2023
Last Update Date : 04/28/2023

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Directions to “ REGAN MAE KOEHN ” Practice Location

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