Provider Demographics
NPI:1437404639
Name:EWING, REGINA A (PA-C)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:EWING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REIGN
Other - Middle Name:ALEXANDER
Other - Last Name:EWING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:345 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MADRAS
Mailing Address - State:OR
Mailing Address - Zip Code:97741-1501
Mailing Address - Country:US
Mailing Address - Phone:904-846-8574
Mailing Address - Fax:
Practice Address - Street 1:345 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-1501
Practice Address - Country:US
Practice Address - Phone:904-846-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA2097462084P0800X
AZ5281363AM0700X
FLPA9106625363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1437404639Medicaid
TX1437404639Medicaid
TXPA12239OtherTEXAS PA LICENSE
FLPA9113467OtherFLORIDA PA LICENSED