Provider Demographics
NPI:1265524177
Name:REGAN, KEVIN JAY (PA C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAY
Last Name:REGAN
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27829
Mailing Address - Street 2:LOVELACE MEDICAL GROUP
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125
Mailing Address - Country:US
Mailing Address - Phone:505-262-7026
Mailing Address - Fax:505-727-9276
Practice Address - Street 1:5400 GIBSON SE
Practice Address - Street 2:LOVELACE MEDICAL CENTER
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-262-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMPA20030004363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical