Provider Demographics
NPI:1316245301
Name:AUTREY, REBECCA LEE BRANUM (PNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE BRANUM
Last Name:AUTREY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 OFFICE PARK DR
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-3432
Mailing Address - Country:US
Mailing Address - Phone:251-968-2323
Mailing Address - Fax:251-968-2134
Practice Address - Street 1:232 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3432
Practice Address - Country:US
Practice Address - Phone:251-968-2323
Practice Address - Fax:251-968-2134
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-119386363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics