MEDICARE: JOHN HUNTER RACKLEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1902248529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN HUNTER RACKLEY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 296
Second Line	:
City	:	ODEM
State	:	TX
Zip	:	78370-0296
Country	:	US
Telephone Number	:	361-816-4270
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 E MARKET ST
Second Line	:
City	:	SINTON
State	:	TX
Zip	:	78387-2640
Country	:	US
Telephone Number	:	361-364-0650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	07/24/2013

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Directions to “ JOHN HUNTER RACKLEY PA-C” Practice Location

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