Provider Demographics
NPI:1457173163
Name:BEAN, REBECCA (CPNP-PC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BEAN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 OWEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-1409
Mailing Address - Country:US
Mailing Address - Phone:713-992-0225
Mailing Address - Fax:
Practice Address - Street 1:113 OWEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-1409
Practice Address - Country:US
Practice Address - Phone:713-992-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178396363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics