Active NPI
Kathleen M. Reagan, P.A.-C
- Physician Assistant
- Fayetteville, NC
National Provider Identifier
1407907454
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 100973
- Practice address
- 806 Hay St
Fayetteville, NC 28305-5312 - Phone
- (910) 860-7008
- Fax
- (910) 221-9006
- NPI assigned
- Jan 16, 2007
- Last updated
- Feb 3, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 100973 | NC | Primary |
Addresses
Primary practice location
806 Hay St
Fayetteville, NC 28305-5312
Mailing address
806 Hay St
Fayetteville, NC 28305-5312
Phone (910) 860-7008
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100973 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Breezewood Healthcare, P.a. | Past | Accepting new patients | |
| Breezewood Family Healthcare, PA | Past | Accepting new patients | |
| South Whiteville Urgent Care & Family Practice PA | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Fayetteville, NC
- NPI 1356404453
-
- General Practice Physician
- Fayetteville, NC
- NPI 1023337276
-
- Family Medicine Physician
- Holly Ridge, NC
- NPI 1740463140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580688000000",
"number": "1407907454",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "806 HAY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283055312",
"telephone_number": "910-860-7008",
"fax_number": "910-221-9006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "806 HAY ST",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283055312",
"telephone_number": "910-860-7008",
"fax_number": "910-221-9006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REAGAN",
"first_name": "KATHLEEN",
"middle_name": "M.",
"name_prefix": "Mrs.",
"credential": "P.A.-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2020-02-03",
"certification_date": "2020-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "100973",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.