Provider Demographics
NPI:1932203106
Name:RAGLE, NITA M (PA)
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:M
Last Name:RAGLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732973
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2973
Mailing Address - Country:US
Mailing Address - Phone:817-702-8450
Mailing Address - Fax:
Practice Address - Street 1:4701 BRYANT IRVIN RD N
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7627
Practice Address - Country:US
Practice Address - Phone:817-702-1100
Practice Address - Fax:817-569-9069
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX830N23OtherBCBS
TX811N73OtherBCBS
TX207402301Medicaid
TX207402302Medicaid
TX207402304Medicaid
TXP00848337OtherRAILROAD MEDICARE
TX8L24960Medicare PIN
TX811N73OtherBCBS
TX207402302Medicaid
TX207402301Medicaid