Basic Information
| Provider Information | |||||||||
| NPI: | 1295924793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUNEYCUTT | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601888 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049821590 | ||||||||
| FaxNumber: | 7045124838 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 YADKIN ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ALBEMARLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280013449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049821590 | ||||||||
| FaxNumber: | 7045124838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2007 | ||||||||
| LastUpdateDate: | 03/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 397 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 146172 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 147VC | 01 | NC | BCBS | OTHER | 7002101 | 05 | NC | MEDICAID | 1295924793 | 05 | NC | MEDICAID |