Provider Demographics
NPI:1881842649
Name:RICHARD, REBECCA GAYLE (PA)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:GAYLE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:GAYLE
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2118
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571
Mailing Address - Country:US
Mailing Address - Phone:337-247-8660
Mailing Address - Fax:
Practice Address - Street 1:3975 I-49 SOUTH SERVICE RD
Practice Address - Street 2:SUITE #200
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-594-3980
Practice Address - Fax:337-594-3981
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200240363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical