Provider Demographics
NPI:1568765774
Name:POWELL, REBECCA SMITH (NP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SMITH
Last Name:POWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:NICOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 STARLING ST STE 404
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4269
Mailing Address - Country:US
Mailing Address - Phone:912-466-7660
Mailing Address - Fax:912-264-1526
Practice Address - Street 1:2500 STARLING ST STE 404
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4269
Practice Address - Country:US
Practice Address - Phone:912-466-7660
Practice Address - Fax:912-264-1526
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9359322363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008913700Medicaid