Provider Demographics
NPI:1215687678
Name:KING, REBEKAH J
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 SW 11TH AVE APT B308
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-8267
Mailing Address - Country:US
Mailing Address - Phone:407-552-6153
Mailing Address - Fax:
Practice Address - Street 1:935 NW 42ND TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4767
Practice Address - Country:US
Practice Address - Phone:407-552-6153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program