Provider Demographics
NPI:1184986218
Name:HEAD, REBEKAH ELISE (PA)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ELISE
Last Name:HEAD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ELISE
Other - Last Name:BEATY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:521 MONTGOMERY HWY
Mailing Address - Street 2:STE 117
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1878
Mailing Address - Country:US
Mailing Address - Phone:205-824-4441
Mailing Address - Fax:205-822-3978
Practice Address - Street 1:521 MONTGOMERY HWY
Practice Address - Street 2:STE 117
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1878
Practice Address - Country:US
Practice Address - Phone:205-824-4441
Practice Address - Fax:205-822-3978
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA819363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical