Healthcare Provider Details

I. General information

NPI: 1134088628
Provider Name (Legal Business Name): REBECCA GRACE MAE WHITE HENBEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10584 LAWRENCE 1245
MARIONVILLE MO
65705-8180
US

IV. Provider business mailing address

10584 LAWRENCE 1245
MARIONVILLE MO
65705-8180
US

V. Phone/Fax

Practice location:
  • Phone: 417-440-0690
  • Fax:
Mailing address:
  • Phone: 417-440-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2026011191
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: