Raegan Mavis

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

1175316 Issued in KY

Practice address

57 Dora LN
Greenup, KY 41144-1187

Phone

(866) 233-1955

NPI assigned

Sep 25, 2023

Last updated

Sep 25, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1871372383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790",
            "city": "ASHLAND",
            "state": "KY",
            "postal_code": "411050790",
            "telephone_number": "606-329-8588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 DORA LN",
            "city": "GREENUP",
            "state": "KY",
            "postal_code": "411441187",
            "telephone_number": "866-233-1955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAVIS",
        "first_name": "RAEGAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-25",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KY",
            "license": "1175316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abigail Lemarr, DC
• Joseph Lewis
• Alexis Lynch
• Kirk Macdonald
• Daniel A Martelino, M.D.
• Carla Elizabeth Maye, COTA/L
• Amy Louise McCarty
• Gary Alan McCoy, D.C.
• Brenda McKenzie
• Anne Mertz

• Registered Nurse in Greenup, KY
• Providers in Greenup, KY by specialty
• Registered Nurse in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.