Provider Demographics
NPI:1811004898
Name:CARREON, REBECCA (DNP, FNP, PMHNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CARREON
Suffix:
Gender:F
Credentials:DNP, FNP, PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PARK TEN BLVD STE 200S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4293
Mailing Address - Country:US
Mailing Address - Phone:210-261-1000
Mailing Address - Fax:210-261-1821
Practice Address - Street 1:1920 BURNET ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-2517
Practice Address - Country:US
Practice Address - Phone:210-261-1250
Practice Address - Fax:210-227-7059
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX547032363LF0000X
TXAP108761363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX042510005Medicaid