Provider Demographics
NPI:1679684914
Name:HENDRIX, RHONDA JEANNE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:JEANNE
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-0176
Mailing Address - Country:US
Mailing Address - Phone:580-371-2394
Mailing Address - Fax:580-371-2638
Practice Address - Street 1:512 E 24TH ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-3214
Practice Address - Country:US
Practice Address - Phone:580-371-2394
Practice Address - Fax:580-371-2638
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0032904363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200046940AMedicaid
731506749OtherFEIN
Q41886Medicare UPIN
244511704Medicare ID - Type Unspecified