Provider Demographics
NPI:1407520620
Name:HENDRY, REBEKAH H (NP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:H
Last Name:HENDRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:H
Other - Last Name:CHAMBLESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1509 DULLES DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3718
Mailing Address - Country:US
Mailing Address - Phone:337-408-0797
Mailing Address - Fax:337-943-0830
Practice Address - Street 1:2900 WESTFORK DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70827-0010
Practice Address - Country:US
Practice Address - Phone:337-991-9276
Practice Address - Fax:337-943-0846
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221457363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology