Provider Demographics
NPI:1144225111
Name:RANKIN, REBECCA G (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:G
Last Name:RANKIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 FRONTIER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-6516
Mailing Address - Country:US
Mailing Address - Phone:606-727-5757
Mailing Address - Fax:606-727-5777
Practice Address - Street 1:132 FRONTIER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:KY
Practice Address - Zip Code:40484-6516
Practice Address - Country:US
Practice Address - Phone:606-727-5757
Practice Address - Fax:606-727-5777
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA343363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95002754Medicaid
KY9500275400Medicaid
KY000000221431OtherANTHEM BCBS
KY970026330OtherRAIL ROAD MEDICARE
KYP61671Medicare UPIN
KY0700003Medicare ID - Type Unspecified