Provider Demographics
NPI:1568086411
Name:SCRIPSICK, REBECCA JO (FNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JO
Last Name:SCRIPSICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:JO
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1301 KS HIGHWAY 264
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-5353
Mailing Address - Country:US
Mailing Address - Phone:620-804-0160
Mailing Address - Fax:
Practice Address - Street 1:1301 KS HIGHWAY 264
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-5353
Practice Address - Country:US
Practice Address - Phone:620-804-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79385-092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily