Provider Demographics
NPI:1043557846
Name:WHITTACRE, RHONDA FAYE
Entity Type:Individual
Prefix:MISS
First Name:RHONDA
Middle Name:FAYE
Last Name:WHITTACRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7484
Mailing Address - Country:US
Mailing Address - Phone:405-208-0126
Mailing Address - Fax:
Practice Address - Street 1:1204 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73170-7484
Practice Address - Country:US
Practice Address - Phone:405-208-0126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist