Provider Demographics
NPI:1821342296
Name:LASSETTER, REBECCA JANE (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JANE
Last Name:LASSETTER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MISTLETOE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4048
Mailing Address - Country:US
Mailing Address - Phone:817-338-1300
Mailing Address - Fax:682-747-5141
Practice Address - Street 1:1900 MISTLETOE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4048
Practice Address - Country:US
Practice Address - Phone:817-338-1300
Practice Address - Fax:682-747-5141
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX717350363L00000X, 363LA2100X
TXAP122593363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner