Provider Demographics
NPI:1790299626
Name:RACKLIFFE, VIVIAN DANITA (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:DANITA
Last Name:RACKLIFFE
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:DANITA
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-C
Mailing Address - Street 1:310 STONE PILLAR CT
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-1002
Mailing Address - Country:US
Mailing Address - Phone:830-998-5889
Mailing Address - Fax:
Practice Address - Street 1:100 INTERSTATE 45 N STE 152A
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2837
Practice Address - Country:US
Practice Address - Phone:830-998-5889
Practice Address - Fax:830-998-5889
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135029363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner