Provider Demographics
NPI:1245571694
Name:ABBOTT, REBEKAH JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:JEAN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:JEAN
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:901 E. 104TH ST.
Mailing Address - Street 2:MAILSTOP 400N
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7104
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:5405 W 151ST ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-8700
Practice Address - Country:US
Practice Address - Phone:913-323-8830
Practice Address - Fax:913-323-8831
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-38799207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG93000058Medicare PIN