Individual
REAGAN L IVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
215 KINLAW RD, FAYETTEVILLE, NC 28311-1431
(919) 588-1998
(888) 987-4108
Mailing address
215 KINLAW RD, FAYETTEVILLE, NC 28311-1431
(919) 588-1998
(888) 987-4108
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
900401
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NCB791C615
MEDICARE PTAN
NC
Enumeration date
08/22/2005
Last updated
03/07/2023
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