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General NPI Number Information
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NPI Number | 1770960296
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Entity Type | Individual
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Provider Name | REBECCA D GAYHEART FNP
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Gender | Female
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 1755 AIRWAY AVE
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City | KINGMAN
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State | AZ
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Zip | 86409-3620
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Country | US
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Telephone | 928-681-1234
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Fax | 928-681-1811
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Provider Business Mailing Address
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Address Line | 604 ANN ST SUITE B368
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City | PARKERSBURG
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State | WV
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Zip | 26101-5122
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Country | US
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Telephone | 304-424-4014
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP7971
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP7971
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP7971
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License Number State | AZ
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