Provider Demographics
NPI:1083664643
Name:REAGAN, STEPHANIE A (NP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:A
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 1:124 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-2839
Mailing Address - Country:US
Mailing Address - Phone:765-587-7311
Mailing Address - Fax:
Practice Address - Street 1:124 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-2839
Practice Address - Country:US
Practice Address - Phone:765-587-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001099A363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
708472000OtherUNITED BEHAVIORAL HEALTH
IN000000626434OtherANTHEM BC/BS
IN000000362853OtherANTHEM BCBS
IN000000668347OtherANTHEM BC/BS
IN200508380Medicaid
708472000OtherUNITED BEHAVIORAL HEALTH
IN000000362853OtherANTHEM BCBS
INP01087884Medicare PIN
INP00742237Medicare PIN
IN000000668347OtherANTHEM BC/BS
IN210690EMedicare PIN
Q37845Medicare UPIN
IN265520QMedicare PIN
IN000000626434OtherANTHEM BC/BS