Provider Demographics
NPI:1649218470
Name:LOVELESS, REBECCA ANNE (PA)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:ANNE
Last Name:LOVELESS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-9123
Mailing Address - Fax:314-362-0478
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DEPT EMERGENCY MED
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-362-9123
Practice Address - Fax:314-362-0478
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012016947363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220024297Medicaid
LA2136577Medicaid
TN3661452Medicare Oscar/Certification
P15234Medicare UPIN
MS302I978881Medicare PIN