Provider Demographics
NPI:1750889929
Name:HUEY, REBAKAH LYNNLEE (CPNP - PC/AC)
Entity type:Individual
Prefix:
First Name:REBAKAH
Middle Name:LYNNLEE
Last Name:HUEY
Suffix:
Gender:F
Credentials:CPNP - PC/AC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:L
Other - Last Name:HUEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:2093 RACHEL ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-1633
Mailing Address - Country:US
Mailing Address - Phone:625-236-0566
Mailing Address - Fax:
Practice Address - Street 1:848 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2816
Practice Address - Country:US
Practice Address - Phone:866-870-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31385363LP0200X
MS902310363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05937047Medicaid