Provider Demographics
NPI:1386305969
Name:HARRELL, REBECCA ANNE (MPA, PA-C, CAQ-PSY)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANNE
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MPA, PA-C, CAQ-PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S INDEPENDENCE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1154
Mailing Address - Country:US
Mailing Address - Phone:572-062-6827
Mailing Address - Fax:
Practice Address - Street 1:506 S INDEPENDENCE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1154
Practice Address - Country:US
Practice Address - Phone:756-206-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110010437363AM0700X
TXPA15909363LP0808X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1195811OtherNCCPA