Provider Demographics
NPI:1598068637
Name:KERSHNER, REBECCA YOUNGBLOOD (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:YOUNGBLOOD
Last Name:KERSHNER
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 N LEG RD BLDG A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4402
Mailing Address - Country:US
Mailing Address - Phone:706-667-4285
Mailing Address - Fax:
Practice Address - Street 1:950 LANEY WALKER BLVD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2960
Practice Address - Country:US
Practice Address - Phone:706-721-5931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207255163WC1500X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health