Provider Demographics
NPI:1568799328
Name:KEMP, REGINA LOUISE (LPN)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:LOUISE
Last Name:KEMP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 VALLEY VIEW DR APT 10
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-8499
Mailing Address - Country:US
Mailing Address - Phone:253-341-3049
Mailing Address - Fax:
Practice Address - Street 1:712 VALLEY VIEW DR APT 10
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-8499
Practice Address - Country:US
Practice Address - Phone:253-341-3049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-14
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP46672164W00000X
WALP 00058646164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse