Provider Demographics
NPI:1346347960
Name:ELDER, REGINA M (ARNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:ELDER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-639-9440
Mailing Address - Fax:270-639-9446
Practice Address - Street 1:1871 US HIGHWAY 41A S
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:KY
Practice Address - Zip Code:42409-9448
Practice Address - Country:US
Practice Address - Phone:270-639-9440
Practice Address - Fax:270-639-9446
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4657P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000380663OtherBCBS PROVIDER NUMBER
KY78015179Medicaid
KY4657POtherLICENSE
0683233Medicare PIN
0935805Medicare PIN
KY78015179Medicaid
KY4657POtherLICENSE
0396848Medicare PIN