Provider Demographics
NPI:1699411561
Name:CROOM, REBECCA AUSTON (PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:AUSTON
Last Name:CROOM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 COX BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9478
Mailing Address - Country:US
Mailing Address - Phone:919-734-8440
Mailing Address - Fax:919-734-9387
Practice Address - Street 1:103 COX BLVD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9478
Practice Address - Country:US
Practice Address - Phone:919-734-8440
Practice Address - Fax:919-734-9387
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-12255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant