Provider Demographics
NPI:1437271244
Name:WHITIS, REBECCA J (ARNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:J
Last Name:WHITIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-1916
Mailing Address - Country:US
Mailing Address - Phone:606-678-4761
Mailing Address - Fax:606-676-9671
Practice Address - Street 1:45 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-1295
Practice Address - Country:US
Practice Address - Phone:606-679-4416
Practice Address - Fax:606-679-4419
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY590P363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY20901211Medicaid
KY300604Medicare PIN
KY300704Medicare PIN
KY300504Medicare PIN
KY299904Medicare PIN
KYS39361Medicare UPIN
KY300404Medicare PIN
KY300304Medicare PIN
KY300804Medicare PIN
KY20901211Medicaid
KY300104Medicare PIN
KY300004Medicare PIN