Provider Demographics
NPI:1225270705
Name:RAWDON, ANNA NICOLE (NP-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:NICOLE
Last Name:RAWDON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:NICOLE
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4409 N KICKAPOO AVE STE 121
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1225
Mailing Address - Country:US
Mailing Address - Phone:405-585-0475
Mailing Address - Fax:855-685-0408
Practice Address - Street 1:4409 N KICKAPOO AVE STE 121
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1225
Practice Address - Country:US
Practice Address - Phone:405-585-0475
Practice Address - Fax:855-685-0408
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR00770066363LF0000X
OK77066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200236190AMedicaid
OK200236190AMedicaid