Provider Demographics
NPI:1568648681
Name:PRIM, REBECCA G (PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:G
Last Name:PRIM
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:7050 AIR DEPOT, BLDG 1094
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:73145-8102
Mailing Address - Country:US
Mailing Address - Phone:405-582-6610
Mailing Address - Fax:405-736-3619
Practice Address - Street 1:7050 AIR DEPOT, BLDG 1094
Practice Address - Street 2:
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73145-8102
Practice Address - Country:US
Practice Address - Phone:405-582-6610
Practice Address - Fax:405-736-3619
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2022-12-05
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Provider Licenses
StateLicense IDTaxonomies
OK1690363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant