Provider Demographics
NPI:1689776999
Name:CAGLE, REBECCA (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:CAGLE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38870-0305
Mailing Address - Country:US
Mailing Address - Phone:662-651-4637
Mailing Address - Fax:662-651-4636
Practice Address - Street 1:63420 HIGHWAY 25 N
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MS
Practice Address - Zip Code:38870
Practice Address - Country:US
Practice Address - Phone:662-651-4637
Practice Address - Fax:662-651-4636
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR713597363LF0000X
MSR850534363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117536Medicaid
MS500001446Medicare ID - Type Unspecified
MSQ09711Medicare UPIN
MS00117536Medicaid
MS500001446Medicare Oscar/Certification