Provider Demographics
NPI:1811363070
Name:DENNISTON, REBECCA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:DENNISTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 BAPTIST HEALTH DR STE 690
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9601 BAPTIST HEALTH DR STE 690
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6328
Practice Address - Country:US
Practice Address - Phone:501-227-8422
Practice Address - Fax:501-537-2399
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-613363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical