Provider Demographics
NPI:1215231766
Name:PREGENT, KATHY LYNN
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LYNN
Last Name:PREGENT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4710 LIGHTERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-8124
Mailing Address - Country:US
Mailing Address - Phone:813-504-1565
Mailing Address - Fax:813-643-6630
Practice Address - Street 1:4710 LIGHTERWOOD WAY
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-8124
Practice Address - Country:US
Practice Address - Phone:813-504-1565
Practice Address - Fax:813-643-6630
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-26
Last Update Date:2010-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688427098Medicaid
FL688427096Medicaid