Provider Demographics
NPI:1164970216
Name:PREWITT, REGINA ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ANN
Last Name:PREWITT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4743 MCCORMICK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-8931
Mailing Address - Country:US
Mailing Address - Phone:859-585-8663
Mailing Address - Fax:
Practice Address - Street 1:407 SHOPPERS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1380
Practice Address - Country:US
Practice Address - Phone:859-744-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily