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NPI Code Detail

MEDICARE: MRS. REBECCA MARIE DICICCO PA-C

MEDICARE: MRS. REBECCA MARIE DICICCO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA2025KY

General Provider Information

NPI Number : 1598033235
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REBECCA MARIE DICICCO PA-C
Provider Business Mailing Address
First Line : ONE GI CREDENTIALING DEPARTMENT
Second Line : PO BOX 381468
City : GERMANTOWN
State : TN
Zip : 38183-1468
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1941 BISHOP LN STE 200
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-1973
Country : US
Telephone Number : 502-888-1988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2011
Last Update Date : 03/03/2025

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