Provider Demographics
NPI:1336537919
Name:CARPENTER, REBECCA LYN (ANP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYN
Last Name:CARPENTER
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Gender:
Credentials:ANP
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-747-2066
Mailing Address - Fax:314-362-2357
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:DIV IM GASTROENTEROLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-747-2066
Practice Address - Fax:314-362-2357
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2025-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2014041453363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420019194Medicaid