Individual
MS. REBECCA L MCKINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
9229 LBJ FWY, DALLAS, TX 75243-3405
(817) 589-4628
(817) 447-1135
Mailing address
1604 BARREL OAK DRIVE, BURLESSON, TX 76028
(817) 875-3417
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
577780
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154880201
—
TX
05
—
154880202
—
TX
05
—
154880203
—
TX
05
—
154880204
—
TX
05
—
154880205
—
TX
01
—
819N63
BCBS
TX
Enumeration date
09/23/2005
Last updated
01/17/2025
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