Provider Demographics
NPI:1770960296
Name:GAYHEART, REBECCA D (FNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:D
Last Name:GAYHEART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 ANN ST
Mailing Address - Street 2:SUITE B368
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5122
Mailing Address - Country:US
Mailing Address - Phone:304-424-4014
Mailing Address - Fax:
Practice Address - Street 1:1755 AIRWAY AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-3620
Practice Address - Country:US
Practice Address - Phone:928-681-1234
Practice Address - Fax:928-681-1811
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7971363L00000X, 363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily