Provider Demographics
NPI:1548492135
Name:RICHARDS-HACK, REBECCA K
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:RICHARDS-HACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:K
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:1915 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2300
Mailing Address - Country:US
Mailing Address - Phone:865-331-2863
Mailing Address - Fax:865-331-2823
Practice Address - Street 1:1915 WHITE AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2300
Practice Address - Country:US
Practice Address - Phone:865-331-2863
Practice Address - Fax:865-331-2823
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33508363LF0000X
VA0024189701363LF0000X
IAA145849363LF0000X
WI71363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ082061Medicaid
WI43811300Medicaid