Basic Information
Provider Information
NPI: 1114204187
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TURNER
FirstName: REBECCA
MiddleName: LEIGH
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MUTTER
OtherFirstName: REBECCA
OtherMiddleName: LEIGH
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 6350 W A J HWY
Address2: DEPARTMENT 100
City: TALBOTT
State: TN
PostalCode: 378778605
CountryCode: US
TelephoneNumber: 8003553565
FaxNumber: 4237142355
Practice Location
Address1: 215 HEDRICK DR
Address2:  
City: NEWPORT
State: TN
PostalCode: 378212902
CountryCode: US
TelephoneNumber: 4236235301
FaxNumber: 4236250808
Other Information
ProviderEnumerationDate: 11/04/2011
LastUpdateDate: 11/04/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163WP0808XRN182278TNY Nursing Service ProvidersRegistered NursePsych/Mental Health

No ID Information.


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