Provider Demographics
NPI:1013585272
Name:REAGAN, AMY (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CENTRAL AVE W
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38556-3557
Mailing Address - Country:US
Mailing Address - Phone:931-752-3221
Mailing Address - Fax:931-752-3253
Practice Address - Street 1:208 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:TN
Practice Address - Zip Code:38556-3557
Practice Address - Country:US
Practice Address - Phone:931-752-3221
Practice Address - Fax:931-752-3253
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN147985163W00000X
KY3016278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse