Provider Demographics
NPI:1487412003
Name:HULL, REBECCA (AGNP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HULL
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31864 LINDER RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-1516
Mailing Address - Country:US
Mailing Address - Phone:225-278-8286
Mailing Address - Fax:
Practice Address - Street 1:315 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4722
Practice Address - Country:US
Practice Address - Phone:225-667-5110
Practice Address - Fax:833-357-1731
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA234599363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology