Provider Demographics
NPI:1043276439
Name:GARTNER, REBECCA L (ANP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:GARTNER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 CENTRAL AVE.
Mailing Address - Street 2:STE N.
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6475
Mailing Address - Country:US
Mailing Address - Phone:501-623-6100
Mailing Address - Fax:501-623-6187
Practice Address - Street 1:3633 CENTRAL AVE.
Practice Address - Street 2:STE N.
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6475
Practice Address - Country:US
Practice Address - Phone:501-623-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01546ANP363LF0000X
ARA01546207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARA01546OtherSTATE LICENSE
AR179169758Medicaid
AR5W998Medicare PIN
AR179169758Medicaid