Basic Information
| Provider Information | |||||||||
| NPI: | 1093033284 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RATTRAY | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | JENNA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, MSN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840026 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062126965 | ||||||||
| FaxNumber: | 8062126278 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 S SONCY RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791196407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062126353 | ||||||||
| FaxNumber: | 8062120558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2010 | ||||||||
| LastUpdateDate: | 09/28/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 716269 | TX | N | Nursing Service Providers | Registered Nurse | 363LF0000X | AP118990 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.