Basic Information
| Provider Information | |||||||||
| NPI: | 1154687432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REAGAN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | HOLLEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 MORRIS CIR | ||||||||
| Address2: | |||||||||
| City: | HOMER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710402109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189276777 | ||||||||
| FaxNumber: | 3189276714 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 MORRIS CIR | ||||||||
| Address2: | |||||||||
| City: | HOMER | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710402109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3189276777 | ||||||||
| FaxNumber: | 3189276714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2012 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD.207697 | LA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.