Healthcare Provider Details

I. General information

NPI: 1619536794
Provider Name (Legal Business Name): REBECCA WHITWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 LANGDON ST
SOMERSET KY
42503-2750
US

IV. Provider business mailing address

350 HOSPITAL WAY
SOMERSET KY
42503-2872
US

V. Phone/Fax

Practice location:
  • Phone: 606-875-5206
  • Fax:
Mailing address:
  • Phone: 606-451-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59455
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: