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General NPI Number Information
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NPI Number | 1740691708
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Entity Type | Individual
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Provider Name | REBECCA KATHRYN PRIVON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 4 MEDICAL BLVD
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City | HATTIESBURG
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State | MS
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Zip | 39401-7230
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Country | US
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Telephone | 601-579-5444
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Fax | 601-579-3083
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Provider Business Mailing Address
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Address Line | 3277 E LOUISE DR STE 350
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City | MERIDIAN
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State | ID
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Zip | 83642-5510
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Country | US
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Telephone | 208-887-9500
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Fax | 208-887-9800
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R895251
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R895251
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | R895251
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License Number State | MS
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