Provider Demographics
NPI:1245453836
Name:WHIFFEN, REBECCA J (FNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:WHIFFEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 HIGHLANDS PLAZA DR E
Mailing Address - Street 2:STE 375
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1392
Mailing Address - Country:US
Mailing Address - Phone:314-367-3113
Mailing Address - Fax:314-454-9382
Practice Address - Street 1:1110 HIGHLANDS PLAZA DR E
Practice Address - Street 2:STE 375
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1392
Practice Address - Country:US
Practice Address - Phone:314-367-3113
Practice Address - Fax:314-454-9382
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO098711363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1245453836Medicaid
MO1245453836OtherANTHEM BCBS
MO926713OtherHEALTHLINK
MO098711OtherRN LICENSE
MO132470075Medicare PIN