Provider Demographics
NPI:1992814495
Name:CAVANAUGH, REGINA KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:KRISTINE
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:36065 SANTE FE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-4752
Mailing Address - Country:US
Mailing Address - Phone:254-286-7079
Mailing Address - Fax:254-286-7629
Practice Address - Street 1:36065 SANTE FE AVE
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-4752
Practice Address - Country:US
Practice Address - Phone:254-286-7079
Practice Address - Fax:254-286-7629
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ40312084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096892705Medicaid
TX096892705Medicaid