Provider Demographics
NPI:1124898093
Name:WRATHER, RAINA MACY (PA-C)
Entity type:Individual
Prefix:
First Name:RAINA
Middle Name:MACY
Last Name:WRATHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HULBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74441-8901
Mailing Address - Country:US
Mailing Address - Phone:918-708-3602
Mailing Address - Fax:
Practice Address - Street 1:129 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HULBERT
Practice Address - State:OK
Practice Address - Zip Code:74441-8901
Practice Address - Country:US
Practice Address - Phone:918-708-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5130363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant