Provider Demographics
NPI:1134453913
Name:LEGGETT, REGINA FAYE (RN)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:FAYE
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 LIGHT ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3223
Mailing Address - Country:US
Mailing Address - Phone:731-676-6763
Mailing Address - Fax:
Practice Address - Street 1:425 LIGHT ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3223
Practice Address - Country:US
Practice Address - Phone:731-676-6763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000101443163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse