Provider Demographics
NPI:1770656456
Name:HAMMOND, REBECCA DAWN (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DAWN
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NEWCOMB AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-2725
Mailing Address - Country:US
Mailing Address - Phone:606-256-4148
Mailing Address - Fax:606-256-5191
Practice Address - Street 1:140 NEWCOMB AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2725
Practice Address - Country:US
Practice Address - Phone:606-256-4148
Practice Address - Fax:606-256-5191
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39802207Q00000X
KY37032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37903705OtherMEDICAID LAB GRP
GAP00175090OtherRR MEDICARE PIN
GACB5773OtherRR MEDICARE GRP
KY4000501OtherMEDICARE LAB GRP
GACB5773OtherRR MEDICARE GRP
GAP00175090OtherRR MEDICARE PIN
KY0623734Medicare ID - Type Unspecified
KY0683638Medicare ID - Type Unspecified