Provider Demographics
NPI:1033313846
Name:BEVINS, RACHEL EZELL (DO)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:EZELL
Last Name:BEVINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 WHITE ST NE
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2913
Mailing Address - Country:US
Mailing Address - Phone:276-628-4335
Mailing Address - Fax:276-628-3195
Practice Address - Street 1:1019 CUMBERLAND FALLS HWY STE D141
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2796
Practice Address - Country:US
Practice Address - Phone:606-528-5527
Practice Address - Fax:606-526-9687
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2214207V00000X
VA0102204565207V00000X
KY04294207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524686Medicaid
VA1033313846Medicaid
KY7100550410Medicaid
TN103I165397Medicare PIN