Provider Demographics
NPI:1437700770
Name:NELMS, REBECCA HOWELL
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:HOWELL
Last Name:NELMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-6015
Mailing Address - Country:US
Mailing Address - Phone:901-604-7830
Mailing Address - Fax:
Practice Address - Street 1:2603 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-6015
Practice Address - Country:US
Practice Address - Phone:901-604-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3747A0650X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider