Provider Demographics
NPI:1073324406
Name:LOUTHEN, REBEKAH JORDAN (FNP-BC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JORDAN
Last Name:LOUTHEN
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 ELDER AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-8073
Mailing Address - Country:US
Mailing Address - Phone:304-887-0663
Mailing Address - Fax:
Practice Address - Street 1:296 ELDER AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24739-8073
Practice Address - Country:US
Practice Address - Phone:304-887-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV106350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine