Provider Demographics
NPI:1811579865
Name:OQUINN, REBECCA SUE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:OQUINN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-2234
Mailing Address - Country:US
Mailing Address - Phone:423-573-1502
Mailing Address - Fax:
Practice Address - Street 1:1225 CLINTWOOD MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-7221
Practice Address - Country:US
Practice Address - Phone:423-573-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017417363LF0000X
VA0024181233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily