Provider Demographics
NPI:1336147818
Name:IRBY, REBECCA LYNN (ANP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNN
Last Name:IRBY
Suffix:
Gender:
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 YADKIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3452
Mailing Address - Country:US
Mailing Address - Phone:704-982-9877
Mailing Address - Fax:
Practice Address - Street 1:303 YAKIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001
Practice Address - Country:US
Practice Address - Phone:980-323-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900388363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
30337OtherPARTNERS MEDICARE
472726OtherMAMSI
SCNP1453Medicaid
NC7004500Medicaid
561845661OtherCHAMPUS
NC1205COtherBLUE CROSS BLUE SHIELD
P91259Medicare UPIN
NC2808831FMedicare PIN
472726OtherMAMSI