Provider Demographics
NPI:1003599630
Name:TRANTHAM, RACHEAL JORDAN (QBHP)
Entity Type:Individual
Prefix:
First Name:RACHEAL
Middle Name:JORDAN
Last Name:TRANTHAM
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 OLD WARREN RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-9713
Mailing Address - Country:US
Mailing Address - Phone:870-367-9035
Mailing Address - Fax:
Practice Address - Street 1:745 OLD WARREN RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-9713
Practice Address - Country:US
Practice Address - Phone:870-367-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator