Provider Demographics
NPI:1811131667
Name:LEDFORD, REGINA ANN (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:ANN
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:STILESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46180-9436
Mailing Address - Country:US
Mailing Address - Phone:540-357-1117
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5187
Practice Address - Country:US
Practice Address - Phone:317-880-5475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009187363LF0000X
IL041362989163W00000X
MO2015042771163W00000X
IL209007596363LF0000X
MO2015042743363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse