Provider Demographics
NPI:1407844996
Name:HETTINGER, RHONDA JOAN (NP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:JOAN
Last Name:HETTINGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 BLACKISTON VIEW DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-2035
Mailing Address - Country:US
Mailing Address - Phone:812-725-1550
Mailing Address - Fax:812-725-1553
Practice Address - Street 1:1615 BLACKISTON VIEW DR
Practice Address - Street 2:SUITE E
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2035
Practice Address - Country:US
Practice Address - Phone:812-725-1550
Practice Address - Fax:812-725-1553
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000764A363LF0000X, 363L00000X
KY3192P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004298Medicaid
IN000000675091OtherANTHEM
IN200265080Medicaid
IN200265080Medicaid
INM400029680Medicare PIN
INP05631Medicare UPIN