Provider Demographics
NPI:1184864241
Name:GENTRY, REBECCA A (PA)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:A
Last Name:GENTRY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:4015 GATEWAY BLVD
Mailing Address - Street 2:STE 2120
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8925
Mailing Address - Country:US
Mailing Address - Phone:812-492-5457
Mailing Address - Fax:812-464-4485
Practice Address - Street 1:4015 GATEWAY BLVD
Practice Address - Street 2:STE 2120
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8925
Practice Address - Country:US
Practice Address - Phone:812-842-0907
Practice Address - Fax:812-464-0536
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2015-12-04
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Provider Licenses
StateLicense IDTaxonomies
IN10001074A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000617297OtherANTHEM
IN532500SSSMedicare PIN