Provider Demographics
NPI:1457785123
Name:YOUNG, REBECCA VANESSA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:VANESSA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:VANESSA
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6738 STATE HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63736-8238
Mailing Address - Country:US
Mailing Address - Phone:573-313-2500
Mailing Address - Fax:573-313-2505
Practice Address - Street 1:109 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-1417
Practice Address - Country:US
Practice Address - Phone:573-359-9803
Practice Address - Fax:573-359-0990
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005027734163W00000X
MO2013013681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420009234Medicaid
MOAPPLYINGMedicare PIN