Provider Demographics
NPI:1083879845
Name:KAVANAUGH, REGINA MICHELLE (LVN)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:MICHELLE
Last Name:KAVANAUGH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12382
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78711-2382
Mailing Address - Country:US
Mailing Address - Phone:512-366-2123
Mailing Address - Fax:
Practice Address - Street 1:1124 RUTLAND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5831
Practice Address - Country:US
Practice Address - Phone:512-366-2123
Practice Address - Fax:512-491-8597
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health