Provider Demographics
NPI:1851112379
Name:HANCOCK, REGAN
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 N ABBEY WAY
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-9441
Mailing Address - Country:US
Mailing Address - Phone:270-839-7205
Mailing Address - Fax:
Practice Address - Street 1:713 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:KY
Practice Address - Zip Code:42220-9229
Practice Address - Country:US
Practice Address - Phone:270-265-5353
Practice Address - Fax:270-265-5350
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4005962363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care