Healthcare Provider Details

I. General information

NPI: 1649668831
Provider Name (Legal Business Name): REBECCA BLEVINS NASH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA GAIL BLEVINS NASH FNP

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 CHILHOWIE ST
CHILHOWIE VA
24319-3461
US

IV. Provider business mailing address

403 CHILHOWIE ST PO BOX 346
CHILHOWIE VA
24319-3461
US

V. Phone/Fax

Practice location:
  • Phone: 276-646-3241
  • Fax: 276-646-2592
Mailing address:
  • Phone: 276-646-3241
  • Fax: 276-646-2592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164017
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: