Healthcare Provider Details

I. General information

NPI: 1356077861
Provider Name (Legal Business Name): REBEKAH K MUNNIKHUYSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 08/04/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S PAGOSA BLVD
PAGOSA SPRINGS CO
81147-8329
US

IV. Provider business mailing address

95 S PAGOSA BLVD
PAGOSA SPRINGS CO
81147-8329
US

V. Phone/Fax

Practice location:
  • Phone: 970-731-3700
  • Fax: 970-731-0511
Mailing address:
  • Phone: 970-731-3700
  • Fax: 970-731-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008626
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0008626
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: