Provider Demographics
NPI:1437774155
Name:GREGORY, REBECCA LYNN (MHS, MS, RDN, PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MHS, MS, RDN, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N. MOSBY AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NC
Mailing Address - Zip Code:27850-9804
Mailing Address - Country:US
Mailing Address - Phone:252-340-5653
Mailing Address - Fax:
Practice Address - Street 1:108 N MOSBY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850-9804
Practice Address - Country:US
Practice Address - Phone:252-586-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005297133V00000X
NC0010-13745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered