Provider Demographics
NPI:1578062436
Name:KIZER, REGINA BETH (DNP, CNM)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:BETH
Last Name:KIZER
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11702 E 105TH PL N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6693
Mailing Address - Country:US
Mailing Address - Phone:918-527-5716
Mailing Address - Fax:
Practice Address - Street 1:1901 S VENTURA AVE STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2700
Practice Address - Country:US
Practice Address - Phone:417-231-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCNM03885207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics