Provider Demographics
NPI:1710297809
Name:QUILLIAMS, REBECCA LEIGH (MSN, FNP-C, RN)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LEIGH
Last Name:QUILLIAMS
Suffix:
Gender:F
Credentials:MSN, FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 TITTSWORTH SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-6007
Mailing Address - Country:US
Mailing Address - Phone:865-640-1290
Mailing Address - Fax:
Practice Address - Street 1:2656 PARKWAY STE 4
Practice Address - Street 2:
Practice Address - City:PIGEON FORGE
Practice Address - State:TN
Practice Address - Zip Code:37863-3392
Practice Address - Country:US
Practice Address - Phone:865-366-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000165542163WE0003X
TN30221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency