| Doctor Name: | MRS. CARLY ANNE PEELER REGAN |
| NPI Number: | 1104192533 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 5005579 |
| Business Practice Address: | 900 Old Winston Rd Ste 222 Kernersville, NC - 272849965 |
| Business Phone Number: | 3369921234 |
| Business Fax Number: | 3369939963 |
| Mailing Address: | 900 Old Winston Rd Ste 222, KERNERSVILLE |
| State: | NC |
| Postal Code: | 272849965 |
| Phone Number: | 3369921234 |
| Fax Number: | 3369939963 |
| NPI Enumeration Date: | 03/29/2012 |
| NPI Last Update Date: | 06/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 5005579 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |