Provider Demographics
NPI:1831628320
Name:BRAUGHTON, REBECCA (MS, APN, CPNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BRAUGHTON
Suffix:
Gender:F
Credentials:MS, APN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5942 APPALOOSA TRL
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-9625
Mailing Address - Country:US
Mailing Address - Phone:773-263-0487
Mailing Address - Fax:
Practice Address - Street 1:3633 REGAL VALLEY DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-8383
Practice Address - Country:US
Practice Address - Phone:877-978-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007165A363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics