Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2012020206 | MO |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 71340 | GA |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | E-11275 | AR |
NPI | 1467717009 |
---|---|
Provider Name | Regina Kathleen Fleming |
First Address | State University, AR 72467-0119 |
Second Address | Jonesboro, AR 72401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 21/08/2018 |