Provider Demographics
NPI:1043245418
Name:JETT, REBECCA JANE (PA)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JANE
Last Name:JETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BECKIE
Other - Middle Name:JANE
Other - Last Name:JETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:9001 S H ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-5948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9001 S H ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-5948
Practice Address - Country:US
Practice Address - Phone:661-328-4260
Practice Address - Fax:661-617-2888
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20526363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical