Provider Demographics
NPI:1043292956
Name:PIERSON, REBEKAH (ARNP)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:PIERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6762
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-0640
Mailing Address - Country:US
Mailing Address - Phone:509-460-4823
Mailing Address - Fax:509-460-4833
Practice Address - Street 1:531 W PARK ST STE 2
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5270
Practice Address - Country:US
Practice Address - Phone:509-547-4411
Practice Address - Fax:509-547-3291
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003677363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7901424Medicaid
OR298897Medicaid
WA9635319Medicaid
OR298897Medicaid
WAP00080794Medicare ID - Type UnspecifiedRAILROAD
WA8805977Medicare ID - Type UnspecifiedARNP
WA9635319Medicaid