Provider Demographics
NPI:1477986115
Name:DEMOSS, REBECA ANN (CNP)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:ANN
Last Name:DEMOSS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:REBECA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-246-7000
Mailing Address - Fax:513-246-7852
Practice Address - Street 1:606 WILSON CREEK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1095
Practice Address - Country:US
Practice Address - Phone:812-496-8779
Practice Address - Fax:812-537-8334
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.333253163W00000X
KY3012856363L00000X
OHCOA.15328-NP363LA2100X
IN71015011A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0152996Medicaid
OHOH 228260Medicare PIN