Healthcare Provider Details

I. General information

NPI: 1679393896
Provider Name (Legal Business Name): KINDRA KAY RHOADS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KINDRA KAY HITTLE RN

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

26007 QUIET DR
SAN ANTONIO TX
78260-5333
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax:
Mailing address:
  • Phone: 916-709-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number988425
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: