Rebecca Denise White, CPRC, CPSS, CPRC SUP

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Practice address

492 Wayne Ave
Pocatello, ID 83201-4541

Phone

(208) 206-2285

NPI assigned

Sep 9, 2022

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Moonlight Mountain Recovery, Inc

  • Substance Abuse Rehabilitation Facility
  • Pocatello, ID
  • NPI 1861983413
  NPD (past)

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

{
    "created_epoch": "1662681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1689395378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2154 E 1340 S",
            "city": "HEBER CITY",
            "state": "UT",
            "postal_code": "840321248",
            "telephone_number": "208-505-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "492 WAYNE AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014541",
            "telephone_number": "208-206-2285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "REBECCA",
        "middle_name": "DENISE",
        "credential": "CPRC, CPSS, CPRC SUP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-09",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krazbitz@outlook.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "492 Wayne Ave",
            "city": "Pocatello",
            "state": "ID",
            "country_code": "US",
            "postal_code": "832014541",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Janean White, ELECTROLOGIST
• Kelley White
• Kevin White
• Leah White
• Mollie White
• Sterling White, PHARMD
• John H Whiting Jr., M.D.
• Donald Maurice Whitley II, PH.D.
• Whole Health Haven
• Rebecca Wickenburg

• All providers in Pocatello, ID
• Peer Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; 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.