MEDICARE: KRISTEN TAYLOR RAINS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	11021636	FL

General Provider Information

NPI Number	:	1053032995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN TAYLOR RAINS NP

Provider Business Mailing Address
First Line	:	2346 RAMSEY RD SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-6223
Country	:	US
Telephone Number	:	860-559-1561
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 N WICKHAM RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32935-2363
Country	:	US
Telephone Number	:	321-775-3334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2022
Last Update Date	:	03/12/2026

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