Provider Demographics
NPI:1275511628
Name:RHOADS, JOANNE KRISTEN (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:KRISTEN
Last Name:RHOADS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:KRISTEN
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFNP
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93653-0307
Mailing Address - Country:US
Mailing Address - Phone:559-304-5700
Mailing Address - Fax:
Practice Address - Street 1:35414 WILLOW DR.
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:CA
Practice Address - Zip Code:93653-0307
Practice Address - Country:US
Practice Address - Phone:559-304-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP5747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGNP000050Medicaid
CAGNP000050Medicaid
CAGNP000050Medicaid
680348501OtherTAX ID NUMBER