Provider Demographics
NPI:1538500814
Name:COOTS, REBECCA J (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:COOTS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8673
Mailing Address - Country:US
Mailing Address - Phone:606-436-0711
Mailing Address - Fax:606-436-0848
Practice Address - Street 1:217 ELM TREE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-2117
Practice Address - Country:US
Practice Address - Phone:859-257-8801
Practice Address - Fax:859-257-2828
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008177363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3008177OtherAPRN LICENSE NUMBER