Provider Demographics
NPI:1770219883
Name:REEVES, REGAN NICOLE (FNP-C, RN)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:NICOLE
Last Name:REEVES
Suffix:
Gender:F
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 BENTLEY DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-1121
Mailing Address - Country:US
Mailing Address - Phone:785-691-8031
Mailing Address - Fax:
Practice Address - Street 1:2560 CENTRAL PARK AVE STE 140
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1566
Practice Address - Country:US
Practice Address - Phone:785-691-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily