Provider Demographics
NPI:1093033284
Name:RATTRAY, KRISTIN JENNA (RN, MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:JENNA
Last Name:RATTRAY
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
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Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6407
Practice Address - Country:US
Practice Address - Phone:806-212-6353
Practice Address - Fax:806-212-0558
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2017-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX716269163W00000X
TXAP118990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX346795YM5UMedicare UPIN