Provider Demographics
NPI:1710011614
Name:ALTSCHUL, REBECKAH B (NP)
Entity type:Individual
Prefix:
First Name:REBECKAH
Middle Name:B
Last Name:ALTSCHUL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-3816
Mailing Address - Country:US
Mailing Address - Phone:817-202-3976
Mailing Address - Fax:817-202-3978
Practice Address - Street 1:805 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3816
Practice Address - Country:US
Practice Address - Phone:817-202-3976
Practice Address - Fax:817-202-3978
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651375363LF0000X
TXAP115637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186990104Medicaid
TX186990101Medicaid
TX186990102Medicaid
TX186990107Medicaid
TX186990103Medicaid
TX8L10040Medicare PIN
TX8J5636Medicare PIN
TX186990107Medicaid
TX186990101Medicaid
TX186990102Medicaid