Provider Demographics
NPI:1154800761
Name:BRACKEN, REBEKAH LEIGH (FNP-C)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LEIGH
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5449 W SAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-7787
Mailing Address - Country:US
Mailing Address - Phone:435-668-9041
Mailing Address - Fax:
Practice Address - Street 1:2351 S RIVER RD STE 5
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8280
Practice Address - Country:US
Practice Address - Phone:435-709-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5151010-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily