Provider Demographics
NPI:1568736650
Name:PIERCE, REBEKAH RUTH (NP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:RUTH
Last Name:PIERCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 NEW SHACKLE ISLAND RD. STE. 122B
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-308-2822
Mailing Address - Fax:615-590-7716
Practice Address - Street 1:353 NEW SHACKLE ISLAND RD. STE. 122B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-308-2822
Practice Address - Fax:615-590-7716
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN186219163W00000X
TN16547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100219140Medicaid
TN1528161Medicaid
TN103I504523Medicare PIN
TN1528161Medicaid