Healthcare Provider Details

I. General information

NPI: 1497981393
Provider Name (Legal Business Name): REBECCA KAY HEFLIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 VT ROUTE 149
WEST PAWLET VT
05775-9798
US

IV. Provider business mailing address

71 ALLEN ST STE 403
RUTLAND VT
05701-4570
US

V. Phone/Fax

Practice location:
  • Phone: 802-645-0580
  • Fax: 802-645-0587
Mailing address:
  • Phone: 802-772-4414
  • Fax: 802-772-7973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRINPP37879
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101-0047022
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: