Provider Demographics
NPI:1417540691
Name:FOGUTH, REBEKAH ELENA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ELENA
Last Name:FOGUTH
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 S ALAMO ST UNIT 2304
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1776
Mailing Address - Country:US
Mailing Address - Phone:630-478-3509
Mailing Address - Fax:
Practice Address - Street 1:1115 S ALAMO ST UNIT 2304
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1776
Practice Address - Country:US
Practice Address - Phone:630-478-3509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029916363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily