Provider Demographics
NPI:1952765018
Name:SANDERS, REBEKAH SCOUT (ACNPC-AG)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:SCOUT
Last Name:SANDERS
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:SUE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-774-8326
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:1348 WALTON WAY STE 5700
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5110
Practice Address - Country:US
Practice Address - Phone:706-722-8242
Practice Address - Fax:706-722-8351
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282064363L00000X
MARN2312926363L00000X
VA0024173413363LA2100X, 363L00000X
WAAP61381088363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology