Provider Demographics
NPI:1043884885
Name:COUCH, REBECCA (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:COUCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 RS COUNTY ROAD 2370
Mailing Address - Street 2:
Mailing Address - City:ALBA
Mailing Address - State:TX
Mailing Address - Zip Code:75410-8065
Mailing Address - Country:US
Mailing Address - Phone:903-330-5140
Mailing Address - Fax:
Practice Address - Street 1:209 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-2604
Practice Address - Country:US
Practice Address - Phone:903-342-3355
Practice Address - Fax:903-342-3350
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015736363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner