Provider Demographics
NPI:1720223894
Name:MCKIMMEY, REBECCA LEE (CNM ANP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:MCKIMMEY
Suffix:
Gender:F
Credentials:CNM ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13210 CLEPPER DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-3037
Mailing Address - Country:US
Mailing Address - Phone:907-795-2479
Mailing Address - Fax:
Practice Address - Street 1:18220 STATE HIGHWAY 249 STE 370
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4349
Practice Address - Country:US
Practice Address - Phone:907-795-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK57176B00000X
AK115320367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife