Provider Demographics
NPI:1326607839
Name:BLACKWELL, REBECCA RUTH (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:RUTH
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 7684
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78683-7684
Mailing Address - Country:US
Mailing Address - Phone:512-676-8537
Mailing Address - Fax:512-697-8421
Practice Address - Street 1:3807 SPANISH BAY CT
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3957
Practice Address - Country:US
Practice Address - Phone:512-745-3781
Practice Address - Fax:512-846-7612
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID78552363LP0808X
TXAP141812363LP0808X
TX30392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily