Provider Demographics
NPI:1851317952
Name:MANAHAN, REBEKAH J (PA-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:J
Last Name:MANAHAN
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 1:3 2200TH ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:KS
Mailing Address - Zip Code:66748-1592
Mailing Address - Country:US
Mailing Address - Phone:620-431-6837
Mailing Address - Fax:
Practice Address - Street 1:220 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:KS
Practice Address - Zip Code:66725-1110
Practice Address - Country:US
Practice Address - Phone:620-429-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS0855363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100447010CMedicaid
042546Medicare ID - Type Unspecified