MEDICARE: KATHERINE M RAINES APMHNP, FNP

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	R851180	MS
2	363LF0000X	Family Nurse Practitioner	R851180	MS
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R851180	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588693634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE M RAINES APMHNP, FNP

Provider Business Mailing Address
First Line	:	2500 N STATE ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4500
Country	:	US
Telephone Number	:	601-984-6426
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 NORTH STATE STREET
Second Line	:	DEPARTMENT OF PSYCHIATRY AND HUMAN BEHAVIOR
City	:	JACKSON
State	:	MS
Zip	:	39216-4505
Country	:	US
Telephone Number	:	601-814-5815
Fax Number	:

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	11/29/2016

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