Reagan E Fernley, PTA

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

8554 Issued in ID

Practice address

134 E Idaho Ave
Homedale, ID 83628-5003

Phone

(208) 337-3254

NPI assigned

Feb 20, 2024

Last updated

Feb 20, 2024By 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

Practice roles

Locations

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.

• Rehabauthority, LLC

  • Multi-Specialty Clinic/Center
  • Grand Forks, ND
  • NPI 1730159690
  NPD

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

{
    "created_epoch": "1708387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1881459543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1217 S BENEWAH ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836862868",
            "telephone_number": "651-788-0664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 E IDAHO AVE",
            "city": "HOMEDALE",
            "state": "ID",
            "postal_code": "836285003",
            "telephone_number": "208-337-3254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERNLEY",
        "first_name": "REAGAN",
        "middle_name": "E",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-20",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "ID",
            "license": "8554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Health Clinics, Inc. (Terry Reilly Health Services)
• Community Health Clinics, Inc. (Terry Reilly Health Services)
• Community Health Clinics, Inc. (Terry Reilly Health Services)
• Community Health Clinics, Inc. (Terry Reilly Health Services)
• Jesse Tyler Cook, DPT
• Stacy Carol Fisher, CMT
• Homedale Healthcare, Inc. (Owyhee Health and Rehabilitation Center)
• Homedale Rural Fire Protection District
• Brett J Homstad, DPT
• Idaho Frontier Wellness

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Homedale, ID
• Providers in Homedale, ID by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; 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.