Rebecca Theresa Medlock, AGACNP-BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

2019029631 Issued in MO

Practice address

736 Marco Valley CT
Fenton, MO 63026-5318

Phone

(314) 413-2187

NPI assigned

Jun 5, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1023632932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "736 MARCO VALLEY CT",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630265318",
            "telephone_number": "314-413-2187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "736 MARCO VALLEY CT",
            "city": "FENTON",
            "state": "MO",
            "postal_code": "630265318",
            "telephone_number": "314-413-2187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLOCK",
        "first_name": "REBECCA",
        "middle_name": "THERESA",
        "credential": "AGACNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-05",
        "last_updated": "2025-09-11",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MO",
            "license": "2019029631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Marie McFarland, PSY.D.
• Courtney McGhee
• McPherson Medical & Diagnostic LLC
• Medcare Physician LLC
• Medexpress Urgent Care Missouri P.C.
• Jason Michael Mehrtens, MD
• Gary E. Meier, P.T.
• John Mellas, MD
• Ashley Menard, MA, LPC
• Stephen Menzel, O.D.

• Gerontology Nurse Practitioner in Fenton, MO
• Providers in Fenton, MO by specialty
• Gerontology Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.