Provider Demographics
NPI:1932675105
Name:RAMIREZ, REBECCA SUE KYLE (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE KYLE
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2780
Mailing Address - Country:US
Mailing Address - Phone:228-206-6882
Mailing Address - Fax:
Practice Address - Street 1:12303 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2780
Practice Address - Country:US
Practice Address - Phone:228-206-6882
Practice Address - Fax:228-832-6221
Is Sole Proprietor?:No
Enumeration Date:2018-10-15
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139232363L00000X
MS904030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner