Provider Demographics
NPI:1649500083
Name:KOON, RITA CAROL (FNP BC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:CAROL
Last Name:KOON
Suffix:
Gender:F
Credentials:FNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 SHERRILL ST STE B
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5891
Mailing Address - Country:US
Mailing Address - Phone:731-885-8884
Mailing Address - Fax:
Practice Address - Street 1:702 SHERRILL ST STE B
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5891
Practice Address - Country:US
Practice Address - Phone:731-885-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014862363LF0000X
TNRN0000106605163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse