Provider Demographics
NPI:1336732221
Name:ANTHONY, RACHELYNN JOY
Entity Type:Individual
Prefix:
First Name:RACHELYNN
Middle Name:JOY
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 KESSLER BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-3828
Mailing Address - Country:US
Mailing Address - Phone:940-531-8292
Mailing Address - Fax:
Practice Address - Street 1:719 SCOTT AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-2605
Practice Address - Country:US
Practice Address - Phone:940-531-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator