Provider Demographics
NPI:1902248529
Name:RACKLEY, JOHN HUNTER (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HUNTER
Last Name:RACKLEY
Suffix:
Gender:M
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:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:ODEM
Mailing Address - State:TX
Mailing Address - Zip Code:78370-0296
Mailing Address - Country:US
Mailing Address - Phone:361-816-4270
Mailing Address - Fax:
Practice Address - Street 1:209 E MARKET ST
Practice Address - Street 2:
Practice Address - City:SINTON
Practice Address - State:TX
Practice Address - Zip Code:78387-2640
Practice Address - Country:US
Practice Address - Phone:361-364-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant