Rebecca Heatherly, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

80366 Issued in GA

Practice address

1501 Georgia Ave
Woodbine, GA 31569-5504

Phone

(912) 576-3040

Fax

(912) 576-3833

NPI assigned

Jul 30, 2012

Last updated

Jul 30, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Practice roles

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

• Camden County Board of Health

  dba Camden County Health Department

  • Public Health or Welfare Agency
  • Kingsland, GA
  • NPI 1013908755
  NPD (past)
• Camden County Board of Health

  dba Camden County Health Department

  • Public Health or Welfare Agency
  • Kingsland, GA
  • NPI 1083605737
  NPD (past)

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

{
    "created_epoch": "1343606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343606400000",
    "number": "1821344763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 SCRANTON CONNECTOR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315250540",
            "telephone_number": "912-280-1462",
            "fax_number": "912-262-3036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 GEORGIA AVE",
            "city": "WOODBINE",
            "state": "GA",
            "postal_code": "315695504",
            "telephone_number": "912-576-3040",
            "fax_number": "912-576-3833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEATHERLY",
        "first_name": "REBECCA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-30",
        "last_updated": "2012-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "GA",
            "license": "80366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Braden William Fuhriman
• Gateway Behavioral Health Services
• Gateway Behavioral Health Services
• Gateway Behavioral Health Services (Camden Peer Support)
• Gateway Behavioral Health Services
• Carmen Hutchinson
• Beth Ann Kelley, RD, CD, CDE
• Kim T. Baird, FNP-CS (Woodbine Family Care Center)
• Tateanna Kozak
• Sabra L. Maddox, RPH

• Licensed Practical Nurse in Woodbine, GA
• Providers in Woodbine, GA by specialty
• Licensed Practical Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; 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.