Provider Demographics
NPI:1255429593
Name:REGAN, KAREN C (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:REGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13316-1428
Mailing Address - Country:US
Mailing Address - Phone:315-245-3192
Mailing Address - Fax:315-245-3195
Practice Address - Street 1:28 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1428
Practice Address - Country:US
Practice Address - Phone:315-245-3192
Practice Address - Fax:315-245-3195
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330615-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF330615-1OtherSTATE LICENSE
MR0059077OtherDEA