Provider Demographics
NPI:1790862886
Name:COREY, REBEKAH S (NP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:S
Last Name:COREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6043 SHALLOWFORD RD STE 113
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1653
Mailing Address - Country:US
Mailing Address - Phone:423-698-1791
Mailing Address - Fax:423-698-4588
Practice Address - Street 1:6043 SHALLOWFORD RD STE 113
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1653
Practice Address - Country:US
Practice Address - Phone:423-698-1791
Practice Address - Fax:423-698-4588
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2020-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN07007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S91251Medicare UPIN