Provider Demographics
NPI:1124501077
Name:DOBBINS, REAGAN AMBER
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:AMBER
Last Name:DOBBINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 LOCKWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TAHOKA
Mailing Address - State:TX
Mailing Address - Zip Code:79373-4118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 LOCKWOOD ST
Practice Address - Street 2:
Practice Address - City:TAHOKA
Practice Address - State:TX
Practice Address - Zip Code:79373-4118
Practice Address - Country:US
Practice Address - Phone:806-998-4604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0038262255A2300X
GAE030790146N00000X
390200000X
TXPA16995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program