Provider Demographics
NPI:1225557598
Name:DAY, REGINA ANN (RD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:DAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:ANN
Other - Last Name:LINGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3800 I-55 NORTH FRONTAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:601-200-6099
Mailing Address - Fax:
Practice Address - Street 1:3800 I 55 NORTH FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-200-6099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS863924133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS863924OtherREGISTERED DIETITIAN