Provider Demographics
NPI:1881827863
Name:SEARS, REAGAN K (CRNA)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:K
Last Name:SEARS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:K
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:8140 N MOPAC EXPY STE 3-210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8862
Mailing Address - Country:US
Mailing Address - Phone:512-343-2292
Mailing Address - Fax:512-343-2745
Practice Address - Street 1:8140 N MOPAC EXPY STE 3-210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8862
Practice Address - Country:US
Practice Address - Phone:512-343-2292
Practice Address - Fax:512-343-2745
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX698489163W00000X
TXAP118659367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2111361-01Medicaid
TX2111361-01Medicaid