Healthcare Provider Details

I. General information

NPI: 1083686232
Provider Name (Legal Business Name): RHONDA RUTH HUIE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHOCTAW WAY
TALIHINA OK
74571-2022
US

IV. Provider business mailing address

PO BOX 415
HEAVENER OK
74937-0415
US

V. Phone/Fax

Practice location:
  • Phone: 918-567-7000
  • Fax: 918-567-7038
Mailing address:
  • Phone: 918-653-3523
  • Fax: 918-567-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1176
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: