MEDICARE: RAIGINA LENETTE PRESTON PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	761386	TX

General Provider Information

NPI Number	:	1396172631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAIGINA LENETTE PRESTON PMHNP-BC

Provider Business Mailing Address
First Line	:	4900 UNION PARK BLVD E
Second Line	:
City	:	AUBREY
State	:	TX
Zip	:	76227-1532
Country	:	US
Telephone Number	:	770-596-5541
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 NORTH COIT RD
Second Line	:	STE 1004
City	:	MCKINNEY
State	:	TX
Zip	:	75071
Country	:	US
Telephone Number	:	469-489-0070
Fax Number	:	469-489-0068

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

Provider Enumeration Date	:	10/01/2013
Last Update Date	:	04/23/2021

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