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NPI Code Detail

MEDICARE: ANGELA DAWN RAINBOLT

MEDICARE: ANGELA DAWN RAINBOLT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1093641748
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA DAWN RAINBOLT
Provider Business Mailing Address
First Line : 3512 IRVING ST
Second Line :
City : MUSKOGEE
State : OK
Zip : 74403-3982
Country : US
Telephone Number : 888-201-3866
Fax Number :
Provider Business Practice Location Address
First Line : 2900 N MAIN ST
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-4078
Country : US
Telephone Number : 908-300-1320
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2026
Last Update Date : 06/22/2026

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Directions to “ ANGELA DAWN RAINBOLT ” Practice Location

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