Provider Demographics
NPI:1437862448
Name:MOTT, REBECKA CHARISSE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECKA
Middle Name:CHARISSE
Last Name:MOTT
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 MITRA DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1988
Mailing Address - Country:US
Mailing Address - Phone:915-497-3795
Mailing Address - Fax:
Practice Address - Street 1:12200 RENFERT WAY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5654
Practice Address - Country:US
Practice Address - Phone:512-652-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner