Provider Demographics
NPI:1073821690
Name:RAYFORD, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:RAYFORD
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 1:2510 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2218
Mailing Address - Country:US
Mailing Address - Phone:806-745-1248
Mailing Address - Fax:
Practice Address - Street 1:2510 80TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2218
Practice Address - Country:US
Practice Address - Phone:806-745-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4491719922-AMedicare UPIN