Provider Demographics
NPI:1669223517
Name:FOSSLER, REAGAN
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:FOSSLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6659 BETHLEHEM RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-7600
Mailing Address - Country:US
Mailing Address - Phone:615-878-0568
Mailing Address - Fax:
Practice Address - Street 1:6659 BETHLEHEM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-7600
Practice Address - Country:US
Practice Address - Phone:615-878-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000000207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine