Provider Demographics
NPI:1154305423
Name:HARRISON, REGINA (RD)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CIVIC CTR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1478
Mailing Address - Country:US
Mailing Address - Phone:859-498-3808
Mailing Address - Fax:859-498-9082
Practice Address - Street 1:117 CIVIC CTR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1478
Practice Address - Country:US
Practice Address - Phone:859-498-3808
Practice Address - Fax:859-498-9082
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1376133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK207520Medicare PIN
KY0984501Medicare ID - Type Unspecified