Provider Demographics
NPI:1972305472
Name:KIRBY, REGAN
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:KIRBY
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 1:1614 SHAMROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:YUTAN
Mailing Address - State:NE
Mailing Address - Zip Code:68073-3050
Mailing Address - Country:US
Mailing Address - Phone:402-889-7092
Mailing Address - Fax:
Practice Address - Street 1:1614 SHAMROCK BLVD
Practice Address - Street 2:
Practice Address - City:YUTAN
Practice Address - State:NE
Practice Address - Zip Code:68073-3050
Practice Address - Country:US
Practice Address - Phone:402-889-7092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program