Provider Demographics
NPI:1841562139
Name:WHITE, REBECCA M (APN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 SPRINGHILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7568
Mailing Address - Country:US
Mailing Address - Phone:501-315-0078
Mailing Address - Fax:501-943-3016
Practice Address - Street 1:2301 SPRINGHILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-7568
Practice Address - Country:US
Practice Address - Phone:501-315-0078
Practice Address - Fax:501-943-3016
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA03441363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193900758Medicaid