1598126427 NPI number — MRS. REBEKKA LEE AMICK AGCNS-BC, AGPCNP-BC

Table of content: MRS. REBEKKA LEE AMICK AGCNS-BC, AGPCNP-BC (NPI 1598126427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598126427 NPI number — MRS. REBEKKA LEE AMICK AGCNS-BC, AGPCNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMICK
Provider First Name:
REBEKKA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AGCNS-BC, AGPCNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598126427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4301 W MARKHAM ST # 783
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-686-8000
Provider Business Mailing Address Fax Number:
501-526-5148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11300 FINANCIAL CENTRE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72211-3746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-614-2340
Provider Business Practice Location Address Fax Number:
501-614-2349
Provider Enumeration Date:
03/20/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  213001 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SA2200X , with the licence number: S002315 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SG0600X , with the licence number: S002315 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 216597758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200692480A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".