Healthcare Provider Details

I. General information

NPI: 1205364783
Provider Name (Legal Business Name): REBECCA SHEPHERD OHEARN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/03/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 ALSTON ST
RICHLAND GA
31825-6012
US

IV. Provider business mailing address

510 ALSTON ST STE A
RICHLAND GA
31825-6012
US

V. Phone/Fax

Practice location:
  • Phone: 229-887-3324
  • Fax:
Mailing address:
  • Phone: 229-887-3324
  • Fax: 229-887-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN205669
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: