Healthcare Provider Details

I. General information

NPI: 1740190388
Provider Name (Legal Business Name): RAINEY ARIZONA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462528 E 1020 RD
SALLISAW OK
74955-4263
US

IV. Provider business mailing address

462528 E 1020 RD
SALLISAW OK
74955-4263
US

V. Phone/Fax

Practice location:
  • Phone: 918-575-1406
  • Fax:
Mailing address:
  • Phone: 918-575-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: