Healthcare Provider Details

I. General information

NPI: 1093641748
Provider Name (Legal Business Name): ANGELA DAWN RAINBOLT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MAIN ST
MUSKOGEE OK
74401-4078
US

IV. Provider business mailing address

3512 IRVING ST
MUSKOGEE OK
74403-3982
US

V. Phone/Fax

Practice location:
  • Phone: 908-300-1320
  • Fax:
Mailing address:
  • Phone: 888-201-3866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: