Provider Demographics
NPI:1134797046
Name:KEMBLE, RITA RENE (BS)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:RENE
Last Name:KEMBLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 EL CAMINO ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-4012
Mailing Address - Country:US
Mailing Address - Phone:580-761-7522
Mailing Address - Fax:
Practice Address - Street 1:20 WHITE EAGLE DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-8310
Practice Address - Country:US
Practice Address - Phone:580-491-2139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator