Provider Demographics
NPI:1134589930
Name:CAUTHEN, REBECCA L (ACNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:CAUTHEN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 SADDLEBROOK CV
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6633
Mailing Address - Country:US
Mailing Address - Phone:601-818-0020
Mailing Address - Fax:
Practice Address - Street 1:189 SADDLEBROOK CV
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6633
Practice Address - Country:US
Practice Address - Phone:601-818-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR901830363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00757226Medicaid