Provider Demographics
NPI:1043778624
Name:MYERS, REBEKAH G (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:G
Last Name:MYERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:G
Other - Last Name:RAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:SAINT MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-0449
Mailing Address - Country:US
Mailing Address - Phone:208-568-7800
Mailing Address - Fax:208-568-7801
Practice Address - Street 1:1745 MAIN AVE
Practice Address - Street 2:
Practice Address - City:SAINT MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1238
Practice Address - Country:US
Practice Address - Phone:208-568-7800
Practice Address - Fax:208-568-7801
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID60895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily