Healthcare Provider Details

I. General information

NPI: 1215312186
Provider Name (Legal Business Name): REBECCA SEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 CUMBERLAND FALLS HWY STE D141
CORBIN KY
40701-2796
US

IV. Provider business mailing address

1019 CUMBERLAND FALLS HWY SUITE B201
CORBIN KY
40701-2735
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-5527
  • Fax: 606-526-9687
Mailing address:
  • Phone: 606-526-9005
  • Fax: 606-526-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009536
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: