Provider Demographics
NPI:1194000869
Name:AUCKER, REBEKAH E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:E
Last Name:AUCKER
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 21ST AVE SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6064
Practice Address - Country:US
Practice Address - Phone:701-838-3150
Practice Address - Fax:701-838-3155
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0494363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA055210OtherMEDICAL PHYSICIAN ASSISTANCE LICENSE
NDPAC0494OtherND STATE LICENSE
PAOA002742OtherOSTEOPATHIC PHYSICIAN ASSISTANT LICENSE