Provider Demographics
NPI:1508863465
Name:MORTON, REBECCA O (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:O
Last Name:MORTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3158 FREEDOM DR STE 3102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0014
Mailing Address - Country:US
Mailing Address - Phone:704-332-0396
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:611 MOCKSVILLE AVE STE 202
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2738
Practice Address - Country:US
Practice Address - Phone:704-786-7770
Practice Address - Fax:704-788-9351
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC201389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004679Medicaid
NC7004679Medicaid
NCNC9860AMedicare PIN