Provider Demographics
NPI:1801441373
Name:GARD, REBECCA LYNN (BSN, RN, CCRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:GARD
Suffix:
Gender:F
Credentials:BSN, RN, CCRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-599-9499
Mailing Address - Fax:
Practice Address - Street 1:9107 NW 45 HWY
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3958
Practice Address - Country:US
Practice Address - Phone:816-251-5775
Practice Address - Fax:816-251-5776
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013019484163WC0200X
KS53-79233363LF0000X
MO2020000702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine