Provider Demographics
NPI:1811024219
Name:WHISNANT ROPER, REGINA LEE (MSN, PMHNP, FNP)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:LEE
Last Name:WHISNANT ROPER
Suffix:
Gender:F
Credentials:MSN, PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3654
Mailing Address - Country:US
Mailing Address - Phone:828-443-2648
Mailing Address - Fax:828-412-0318
Practice Address - Street 1:126 FIDDLERS RUN BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7753
Practice Address - Country:US
Practice Address - Phone:828-443-9609
Practice Address - Fax:828-412-0318
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152520163W00000X
NC5001313363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1811024219Medicaid