Provider Demographics
NPI:1154687432
Name:REAGAN, KIMBERLY HOLLEY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:HOLLEY
Last Name:REAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MORRIS CIR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-2109
Mailing Address - Country:US
Mailing Address - Phone:318-927-6777
Mailing Address - Fax:318-927-6714
Practice Address - Street 1:104 MORRIS CIR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-2109
Practice Address - Country:US
Practice Address - Phone:318-927-6777
Practice Address - Fax:318-927-6714
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.207697208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics