Provider Demographics
NPI:1639394356
Name:GAINES, REBECCA MARIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:MARIA
Last Name:GAINES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:MARIA
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11631 HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:35648-3249
Mailing Address - Country:US
Mailing Address - Phone:256-247-1331
Mailing Address - Fax:256-247-9791
Practice Address - Street 1:2850 HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-6046
Practice Address - Country:US
Practice Address - Phone:256-247-1331
Practice Address - Fax:256-247-9791
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-048778363LF0000X
TN0000013311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS33743Medicare UPIN
AL510I500444Medicare PIN