Provider Demographics
NPI:1831185925
Name:MCKINTOSH, REBECCA L (ACNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:L
Last Name:MCKINTOSH
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 BARREL OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURLESSON
Mailing Address - State:TX
Mailing Address - Zip Code:76028
Mailing Address - Country:US
Mailing Address - Phone:817-875-3417
Mailing Address - Fax:
Practice Address - Street 1:9229 LBJ FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3405
Practice Address - Country:US
Practice Address - Phone:817-589-4628
Practice Address - Fax:817-447-1135
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2025-01-17
Deactivation Date:2024-11-14
Deactivation Code:
Reactivation Date:2025-01-17
Provider Licenses
StateLicense IDTaxonomies
TX577780363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154880203Medicaid
TX154880205Medicaid
TX154880201Medicaid
TX154880204Medicaid
TX154880202Medicaid
TX819N63OtherBCBS
TX154880203Medicaid
TX8L18733Medicare PIN
TX8L18649Medicare PIN
TXTXB100709Medicare PIN
TX154880205Medicaid
TX8L18734Medicare PIN