Provider Demographics
NPI:1265968689
Name:WILSON, REBECCA YEAGER (NP-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:YEAGER
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HUNTINGTON WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-8819
Mailing Address - Country:US
Mailing Address - Phone:304-368-2422
Mailing Address - Fax:304-368-2426
Practice Address - Street 1:1 HUNTINGTON WAY STE 100
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8819
Practice Address - Country:US
Practice Address - Phone:304-368-2422
Practice Address - Fax:304-368-2426
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN83843-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily