Doctor Name: | JAYNE REAGOR |
NPI Number: | 1003993999 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | RN0000098294 |
Business Practice Address: | 210 Manor St Marion, AR - 723641936 |
Business Phone Number: | 8707396818 |
Business Fax Number: | 8707391970 |
Mailing Address: | 1570 Harbert Ave, MEMPHIS |
State: | TN |
Postal Code: | 381045033 |
Phone Number: | 9012301570 |
Fax Number: | |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | RN0000098294 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |