Provider Demographics
NPI:1508011644
Name:ADKISON-YATES, REBEKAH LEEANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:LEEANN
Last Name:ADKISON-YATES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:REBEKAH
Other - Middle Name:LEEANN
Other - Last Name:ADKISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2241 THORNTON TAYLOR PKWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3637
Mailing Address - Country:US
Mailing Address - Phone:931-433-6456
Mailing Address - Fax:931-433-8911
Practice Address - Street 1:2241 THORNTON TAYLOR PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3637
Practice Address - Country:US
Practice Address - Phone:931-433-6456
Practice Address - Fax:931-433-8911
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN66776164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN66776OtherLPN LICENSE