MEDICARE: REBECCA GAYLE WARREN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	31191A	SC

General Provider Information

NPI Number	:	1174489983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA GAYLE WARREN FNP

Provider Business Mailing Address
First Line	:	105 JOHNATHON LN
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-6335
Country	:	US
Telephone Number	:	270-505-2810
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 JOHNATHON LN
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-6335
Country	:	US
Telephone Number	:	270-505-2810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2025
Last Update Date	:	12/25/2025

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