Provider Demographics
NPI:1073324083
Name:LEE, REBEKAH OLIVIA (PA-C, RDN)
Entity type:Individual
Prefix:MISS
First Name:REBEKAH
Middle Name:OLIVIA
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37336-0237
Mailing Address - Country:US
Mailing Address - Phone:423-457-0960
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 237
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TN
Practice Address - Zip Code:37336-0237
Practice Address - Country:US
Practice Address - Phone:423-457-0960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5058133V00000X
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered