Provider Demographics
NPI:1144826975
Name:BAILEY, REBEKAH SHAN (PMHNP- BC)
Entity type:Individual
Prefix:
First Name:REBEKAH
Middle Name:SHAN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PMHNP- BC
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:SHAN
Other - Last Name:HOLCOMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2510 DUNLIN DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-9127
Mailing Address - Country:US
Mailing Address - Phone:864-918-7576
Mailing Address - Fax:
Practice Address - Street 1:134 E REBOUND RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-7712
Practice Address - Country:US
Practice Address - Phone:803-712-3987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2020004149363LP0808X
SC201272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse