Provider Demographics
NPI:1033629050
Name:FERGUSON, REBECCA BREWER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:BREWER
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5457 VILLAGE HWY
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-5387
Mailing Address - Country:US
Mailing Address - Phone:434-485-6101
Mailing Address - Fax:
Practice Address - Street 1:2011 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1111
Practice Address - Country:US
Practice Address - Phone:434-947-3963
Practice Address - Fax:434-947-5935
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005956363A00000X
VA0110-005956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1033629050Medicaid