Provider Demographics
NPI:1891138988
Name:PULLEN, REBECCA JEAN (FNP, CNM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:PULLEN
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:JEAN
Other - Last Name:BEARDSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, CNM
Mailing Address - Street 1:9663 ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:NY
Mailing Address - Zip Code:14744-8736
Mailing Address - Country:US
Mailing Address - Phone:478-396-6469
Mailing Address - Fax:
Practice Address - Street 1:9663 ROUTE 19
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:NY
Practice Address - Zip Code:14744-8736
Practice Address - Country:US
Practice Address - Phone:478-396-6469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001539367A00000X
NY337900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3599048Medicaid
NYJ400213281Medicare PIN