1326607839 NPI number — REBECCA RUTH BLACKWELL MSN, APRN, FNP-C

Table of content: REBECCA RUTH BLACKWELL MSN, APRN, FNP-C (NPI 1326607839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326607839 NPI number — REBECCA RUTH BLACKWELL MSN, APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACKWELL
Provider First Name:
REBECCA
Provider Middle Name:
RUTH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NORTON
Provider Other First Name:
REBECCA
Provider Other Middle Name:
RUTH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326607839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7684
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78683-7684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-676-8537
Provider Business Mailing Address Fax Number:
512-697-8421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3807 SPANISH BAY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78664-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-745-3781
Provider Business Practice Location Address Fax Number:
512-846-7612
Provider Enumeration Date:
06/08/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  78552 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP141812 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 30392 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)