Provider Demographics
NPI:1285144642
Name:LEYVA, REAGAN SHEA (FNP-C)
Entity type:Individual
Prefix:MS
First Name:REAGAN
Middle Name:SHEA
Last Name:LEYVA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 W PIERCE ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3568
Mailing Address - Country:US
Mailing Address - Phone:575-887-0637
Mailing Address - Fax:575-887-0638
Practice Address - Street 1:2402 W PIERCE ST STE 2A
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3568
Practice Address - Country:US
Practice Address - Phone:575-887-0637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily