Provider Demographics
NPI:1376645697
Name:NORTHINGTON, REBECCA CLAIRE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:CLAIRE
Last Name:NORTHINGTON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:CLAIRE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:123 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-3416
Mailing Address - Country:US
Mailing Address - Phone:662-256-7114
Mailing Address - Fax:662-256-7116
Practice Address - Street 1:302 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-6002
Practice Address - Country:US
Practice Address - Phone:662-862-7047
Practice Address - Fax:662-862-7053
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS500002258OtherMS MEDICARE NO.
MS09354827Medicaid
MS500002258Medicare Oscar/Certification
MS09354827Medicaid
Q73708Medicare Oscar/Certification