Provider Demographics
NPI:1659477115
Name:MORGAN, REGAN LEIGH (FNP)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:LEIGH
Last Name:MORGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 GAYTON BLUFFS LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6627
Mailing Address - Country:US
Mailing Address - Phone:804-364-5026
Mailing Address - Fax:
Practice Address - Street 1:411 W RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2938
Practice Address - Country:US
Practice Address - Phone:804-452-3624
Practice Address - Fax:804-452-2827
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166241363L00000X, 207P00000X
VA0001184101207P00000X
TX796913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281909601Medicaid
TX281909603Medicaid
TX281909602Medicaid
TXTXB125789Medicare PIN
VA01984V68Medicare PIN
TX281909603Medicaid
TXTXB125326Medicare PIN
VA009267V21Medicare ID - Type Unspecified
TX281909601Medicaid
TX281909602Medicaid
VA015481V20Medicare PIN
VA009265V01Medicare PIN