Healthcare Provider Details

I. General information

NPI: 1407844996
Provider Name (Legal Business Name): RHONDA JOAN HETTINGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 BLACKISTON VIEW DR SUITE E
CLARKSVILLE IN
47129-2035
US

IV. Provider business mailing address

1615 BLACKISTON VIEW DR SUITE E
CLARKSVILLE IN
47129-2035
US

V. Phone/Fax

Practice location:
  • Phone: 812-725-1550
  • Fax: 812-725-1553
Mailing address:
  • Phone: 812-725-1550
  • Fax: 812-725-1553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000764A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3192P
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000764A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: