Provider Demographics
NPI:1821687187
Name:ADCOCK, REBECCA (CNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ADCOCK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:PROCELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8595 PICARDY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3674
Mailing Address - Country:US
Mailing Address - Phone:225-763-4900
Mailing Address - Fax:
Practice Address - Street 1:8595 PICARDY AVE STE 100
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3674
Practice Address - Country:US
Practice Address - Phone:225-763-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218208363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care