Provider Demographics
NPI:1164950283
Name:OTTAN, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:OTTAN
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 1:7115 S MASON RD APT 1911
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4482
Mailing Address - Country:US
Mailing Address - Phone:248-842-2852
Mailing Address - Fax:
Practice Address - Street 1:8686 HWY 6 NORTH
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:281-861-4212
Practice Address - Fax:281-861-4051
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134113208D00000X
TXF05170039363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF05170039OtherFAMILY NURSE PRACTITIONER
TX1164950283OtherNPI