Healthcare Provider Details

I. General information

NPI: 1497298996
Provider Name (Legal Business Name): REBECCA LYNN SIDBERRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2016
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 NAAB RD STE 1B
INDIANAPOLIS IN
46260-1954
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7490
  • Fax:
Mailing address:
  • Phone: 314-362-3500
  • Fax: 314-230-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016032502
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71017332A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: