Healthcare Provider Details

I. General information

NPI: 1447690714
Provider Name (Legal Business Name): REBECCA A MORTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA A RUSSELL PA-C

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 FOOTE AVE
JAMESTOWN NY
14701-6947
US

IV. Provider business mailing address

3085 HARLEM RD STE 350
CHEEKTOWAGA NY
14225-2591
US

V. Phone/Fax

Practice location:
  • Phone: 716-338-9200
  • Fax: 716-338-9250
Mailing address:
  • Phone: 716-844-5600
  • Fax: 716-844-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016636
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number016636
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: