Provider Demographics
NPI:1578831251
Name:HARDESTY, REBECCA DEEANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:DEEANN
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:701 TUSCAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4133
Mailing Address - Country:US
Mailing Address - Phone:972-401-3200
Mailing Address - Fax:972-401-3230
Practice Address - Street 1:701 TUSCAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4133
Practice Address - Country:US
Practice Address - Phone:972-401-3200
Practice Address - Fax:972-401-3230
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02569363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical