Provider Demographics
NPI:1962041715
Name:PRIODE, REBECCA (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PRIODE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 21ST ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7726
Mailing Address - Country:US
Mailing Address - Phone:606-325-6493
Mailing Address - Fax:606-324-9101
Practice Address - Street 1:330 21ST ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7726
Practice Address - Country:US
Practice Address - Phone:606-325-6493
Practice Address - Fax:606-324-9101
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013259363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology