Provider Demographics
NPI:1164414538
Name:IVEY, REAGAN L (NP)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:L
Last Name:IVEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:L
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:215 KINLAW RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1431
Mailing Address - Country:US
Mailing Address - Phone:919-588-1998
Mailing Address - Fax:888-987-4108
Practice Address - Street 1:215 KINLAW RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1431
Practice Address - Country:US
Practice Address - Phone:919-588-1998
Practice Address - Fax:888-987-4108
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900401363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCB791C615OtherMEDICARE PTAN
NCNCB791C615OtherMEDICARE PTAN