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General NPI Number Information
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NPI Number | 1568091684
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Entity Type | Individual
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Provider Name | REBECCA JO KEBBERLY NP
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Gender | Female
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 121 PARK CENTRAL DR STE 200
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City | COLUMBIA
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State | SC
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Zip | 29203-6476
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Country | US
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Telephone | 803-252-9907
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Fax | 803-252-9906
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Provider Business Mailing Address
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Address Line | 121 PARK CENTRAL DR STE 200
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City | COLUMBIA
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State | SC
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Zip | 29203-6476
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Country | US
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Telephone | 803-252-9907
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Fax | 803-252-9906
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 26477
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License Number State | SC
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