Provider Demographics
NPI:1003843145
Name:POE, REAGAN (PA)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:POE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MT PARKWAY SPUR
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301
Mailing Address - Country:US
Mailing Address - Phone:606-668-6932
Mailing Address - Fax:
Practice Address - Street 1:1903 BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7105
Practice Address - Country:US
Practice Address - Phone:270-444-8183
Practice Address - Fax:270-444-8147
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005468Medicaid
KY000000388604OtherANTHEM BC/BS
KYQ36740Medicare UPIN
KY000000388604OtherANTHEM BC/BS