Provider Demographics
NPI:1386317915
Name:FAIRCHILD, REBEKAH ANN (CNP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:ANN
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396245 W 3250 DR
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:OK
Mailing Address - Zip Code:74061-3457
Mailing Address - Country:US
Mailing Address - Phone:918-232-8564
Mailing Address - Fax:
Practice Address - Street 1:3460 E FRANK PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2406
Practice Address - Country:US
Practice Address - Phone:918-332-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK202147363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK202147OtherOK BOARD OF NURSING LICENSE