Provider Demographics
NPI:1760768055
Name:GAFFIN, REBEKAH LYN (FNP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYN
Last Name:GAFFIN
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 1:611 W. PARK AVE
Mailing Address - Street 2:BWPC
Mailing Address - City:URBABA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6941
Mailing Address - Fax:217-258-5904
Practice Address - Street 1:2512 HURST DRIVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9388
Practice Address - Country:US
Practice Address - Phone:217-258-5900
Practice Address - Fax:217-258-5904
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF40009275Medicare UPIN