Provider Demographics
NPI:1528353851
Name:CARSON, REBECCA ANN (CPNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:CARSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 HATCHES POND LN STE 101
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6294
Mailing Address - Country:US
Mailing Address - Phone:919-467-7425
Mailing Address - Fax:
Practice Address - Street 1:1125 HATCHES POND LN STE 101
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6294
Practice Address - Country:US
Practice Address - Phone:919-467-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021679363L00000X
KY3006950363LP0200X
NC5013743363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201032890Medicaid
KY71001174030Medicaid
KYK011520Medicare PIN