Provider Demographics
NPI:1649689720
Name:EMERSON, REBECCA LOUISE (NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LOUISE
Last Name:EMERSON
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:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:407 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2771
Practice Address - Country:US
Practice Address - Phone:864-429-8846
Practice Address - Fax:864-429-9093
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007060363LP0200X
SC28044363LP0200X
NC229060363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCR298H985OtherMEDICARE PIN
SCNP6679Medicaid