Provider Demographics
NPI:1710379664
Name:DAVIS, REBBEKAH
Entity Type:Individual
Prefix:
First Name:REBBEKAH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
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 1152
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76068-1152
Mailing Address - Country:US
Mailing Address - Phone:940-325-2706
Mailing Address - Fax:940-325-4130
Practice Address - Street 1:801 E WALKER ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:TX
Practice Address - Zip Code:76424-3745
Practice Address - Country:US
Practice Address - Phone:254-559-2345
Practice Address - Fax:254-559-9200
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0035334332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0565110001Medicare NSC