Basic Information
Provider Information
NPI: 1972088938
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILLER
FirstName: REBEKAH
MiddleName: J
NamePrefix: MRS.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1021 DARRINGTON DR STE 101
Address2:  
City: CARY
State: NC
PostalCode: 275138158
CountryCode: US
TelephoneNumber: 9198523999
FaxNumber: 9193789114
Practice Location
Address1: 804 ENGLISH RD STE 100
Address2:  
City: ROCKY MOUNT
State: NC
PostalCode: 278046027
CountryCode: US
TelephoneNumber: 2524433133
FaxNumber: 2524430847
Other Information
ProviderEnumerationDate: 09/26/2018
LastUpdateDate: 01/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X0010-08476NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
207Q00000X0010-08476NCN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home