Provider Demographics
NPI:1144234337
Name:SMITH, REBECCA M (ANP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:5875 BREMO RD
Mailing Address - Street 2:SUITE 512
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1934
Mailing Address - Country:US
Mailing Address - Phone:804-521-5800
Mailing Address - Fax:804-545-4340
Practice Address - Street 1:7401 BEAUFONT SPRINGS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5520
Practice Address - Country:US
Practice Address - Phone:804-323-5011
Practice Address - Fax:804-323-5120
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024102437363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health