Provider Demographics
NPI:1346506615
Name:NASS, REBECCA AMY (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:AMY
Last Name:NASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-425-5752
Mailing Address - Fax:731-425-5783
Practice Address - Street 1:2863 HIGHWAY 45 BYP
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3618
Practice Address - Country:US
Practice Address - Phone:731-664-1375
Practice Address - Fax:731-660-8366
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2015-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN51363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014499Medicaid
TN103I083190Medicare PIN