Provider Demographics
NPI:1245226737
Name:HAMILTON, REBECCA JANE (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JANE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 PAVILION DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4657
Mailing Address - Country:US
Mailing Address - Phone:423-392-6100
Mailing Address - Fax:423-392-6159
Practice Address - Street 1:2204 PAVILION DR
Practice Address - Street 2:SUITE 108
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4657
Practice Address - Country:US
Practice Address - Phone:423-392-6100
Practice Address - Fax:423-392-6159
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000007612363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524413Medicaid
TNTN0117OtherUNITED HEALTHCARE RIVER V
TN4306925OtherBCBS TENNESSEE
VA010018404Medicaid
3909863Medicare PIN
TNTN0117OtherUNITED HEALTHCARE RIVER V
P90261Medicare UPIN