Provider Demographics
NPI:1710755970
Name:KING, REBEKAH IRENE (FNP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:IRENE
Last Name:KING
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 TURKEY FARM LN
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5241
Mailing Address - Country:US
Mailing Address - Phone:207-460-8837
Mailing Address - Fax:
Practice Address - Street 1:50 WATER ST.
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605
Practice Address - Country:US
Practice Address - Phone:207-664-5672
Practice Address - Fax:207-664-5963
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner