Provider Demographics
NPI:1528400918
Name:YOUNG, REBECCA ANN T (FNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA ANN
Middle Name:T
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:REBECCA ANN
Other - Middle Name:TENNEY
Other - Last Name:BEAHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9407 CUMBERLAND RD STE A
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124-2029
Mailing Address - Country:US
Mailing Address - Phone:804-996-2242
Mailing Address - Fax:
Practice Address - Street 1:9407 CUMBERLAND RD STE A
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124-2029
Practice Address - Country:US
Practice Address - Phone:804-996-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171360363L00000X
VA0024173140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner