Provider Demographics
NPI:1609318393
Name:HAYES, REBEKAH LEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:LEE
Last Name:HAYES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:REBEKAH
Other - Middle Name:LEE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:4142 MILL ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2540
Practice Address - Country:US
Practice Address - Phone:770-225-0098
Practice Address - Fax:770-787-2304
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262600363LA2200X, 363LG0600X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I505188Medicare PIN
GA202I505190Medicare PIN