Provider Demographics
NPI:1982842217
Name:RATHER, MARY A (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:RATHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:KEYWORTH, NANNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5701 BRYANT IRVIN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4026
Mailing Address - Country:US
Mailing Address - Phone:817-263-2500
Mailing Address - Fax:817-346-4006
Practice Address - Street 1:5701 BRYANT IRVIN RD STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4026
Practice Address - Country:US
Practice Address - Phone:817-263-2500
Practice Address - Fax:817-346-4006
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372007YKPWMedicare PIN