Provider Demographics
NPI:1184708687
Name:DE REGNIER, KEVIN VINCENT (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:VINCENT
Last Name:DE REGNIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W. HUTCHINGS ST.
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273
Mailing Address - Country:US
Mailing Address - Phone:515-462-2950
Mailing Address - Fax:515-462-4371
Practice Address - Street 1:300 W. HUTCHINGS ST.
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273
Practice Address - Country:US
Practice Address - Phone:515-462-2950
Practice Address - Fax:515-462-4371
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2037549Medicaid
IA249276OtherWELLMARK BC/BS #
IA24927Medicare PIN
IA2037549Medicaid