Provider Demographics
NPI:1043090103
Name:RHINE, JENNIFER RUTH (APRN-CNP, PMHNP,BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:RHINE
Suffix:
Gender:F
Credentials:APRN-CNP, PMHNP,BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RUTH
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1738
Mailing Address - Country:US
Mailing Address - Phone:918-636-6370
Mailing Address - Fax:
Practice Address - Street 1:2050 LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1738
Practice Address - Country:US
Practice Address - Phone:918-636-6370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK216100363LP0808X
OKR0130893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse