Provider Demographics
NPI:1124552369
Name:BANFIELD, REBECCA (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BANFIELD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:BANFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3503 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2611
Mailing Address - Country:US
Mailing Address - Phone:606-242-3100
Mailing Address - Fax:606-242-3984
Practice Address - Street 1:2317 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2834
Practice Address - Country:US
Practice Address - Phone:606-242-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009068A363LF0000X
KY3011074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty