Provider Demographics
NPI:1780198572
Name:HARRELL, REGINA (FNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:HARRELL
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 1:1303 WATER PLANT RD
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-8615
Mailing Address - Country:US
Mailing Address - Phone:919-404-2474
Mailing Address - Fax:919-375-4150
Practice Address - Street 1:1303 WATER PLANT RD
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-8615
Practice Address - Country:US
Practice Address - Phone:919-404-2474
Practice Address - Fax:919-375-4150
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily