Provider Demographics
NPI:1699208041
Name:FERRELL, REGINA GRACE (BSW, MSW, CM)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:GRACE
Last Name:FERRELL
Suffix:
Gender:F
Credentials:BSW, MSW, CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 HECKS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8423
Mailing Address - Country:US
Mailing Address - Phone:859-209-2361
Mailing Address - Fax:606-783-0110
Practice Address - Street 1:550 HECKS PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-8423
Practice Address - Country:US
Practice Address - Phone:859-209-2361
Practice Address - Fax:606-783-0110
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY26-2917723Medicaid