Healthcare Provider Details

I. General information

NPI: 1780184697
Provider Name (Legal Business Name): RAINEY JO HITT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2018
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11806 HARBOR VIEW ST
THACKERVILLE OK
73459-9405
US

IV. Provider business mailing address

11806 HARBOR VIEW ST
THACKERVILLE OK
73459-9405
US

V. Phone/Fax

Practice location:
  • Phone: 940-231-7729
  • Fax:
Mailing address:
  • Phone: 940-231-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number927388
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: