Rebecca Theresa Medlock
Nurse Practitioner - Gerontology
736 Marco Valley Ct
Fenton
, Missouri 63026-5318
Rebecca Theresa Medlock
Nurse Practitioner - Gerontology
736 Marco Valley Ct
Fenton
, Missouri 63026-5318
(314) 413-2187
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About
Features
Specialties
- Nurse Practitioner - Gerontology
Languages spoken
- English
Location
First Address
- Rebecca Theresa Medlock
- 736 Marco Valley Ct
- Fenton, MO
- Zip : 63026-5318
- Phone : (314) 413-2187
Second Address
- Rebecca Theresa Medlock
- 736 Marco Valley Ct
- Fenton, MO
- Zip : 63026-5318
- Phone : (314) 413-2187
Reviews
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 363LG0600X | Nurse Practitioner - Gerontology | 2019029631 | MO |
National Provider Identifier
| NPI | 1023632932 |
|---|---|
| Provider Name | Rebecca Theresa Medlock |
| First Address | Fenton, MO 63026-5318 |
| Second Address | Fenton, MO 63026-5318 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 05/06/2020 |
| Last Update Date | 08/07/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.